Rajdev Kartikeya, Idiculla Pretty Sara, Sharma Shubham, Von Essen Susanna G, Murphy Peter J, Bista Sabin
Department of Internal Medicine, Division of Pulmonary, Critical Care & Sleep Medicine, University of Nebraska Medical Center, 42nd and Emile St., Omaha, Nebraska 68198-7400, USA.
Sree Gokulam Medical College & Research Foundation, Kerala, India.
Case Rep Pulmonol. 2020 Dec 1;2020:8898621. doi: 10.1155/2020/8898621. eCollection 2020.
Pulmonary barotrauma such as pneumothorax (PTX) is a known complication of invasive mechanical ventilation. However, it is uncommonly reported with the use of noninvasive positive pressure ventilation (NPPV) and CPAP (continuous positive airway pressure) therapy. We present a case of a 66-year-old female who presented with chronic dyspnea on exertion secondary to right-sided diaphragmatic hernia. The patient also underwent a home sleep study which suggested obstructive sleep apnea (OSA) for which she was initiated on CPAP. She then underwent surgical repair of her right diaphragmatic hernia. The patient developed pneumothorax three times over the course of the following several months, once on the right side and twice on the left side. The patient's incidences of PTX had a temporal association with the CPAP initiation. Her CPAP therapy was discontinued permanently after the third occurrence of PTX. With this case report, we highlight the risk of barotrauma with the use of CPAP for OSA. There are very few reported cases of PTX in association with NPPV therapy for OSA. The lung-protective ventilation strategies and limiting the positive airway pressures can help reduce the risk of pulmonary barotrauma with CPAP.
气胸（PTX）等肺气压伤是有创机械通气已知的并发症。然而，使用无创正压通气（NPPV）和持续气道正压通气（CPAP）治疗时该并发症的报道并不常见。我们报告一例66岁女性患者，因右侧膈疝继发慢性劳力性呼吸困难。该患者还进行了家庭睡眠监测，提示存在阻塞性睡眠呼吸暂停（OSA），为此开始接受CPAP治疗。随后她接受了右侧膈疝修补术。在接下来的几个月里，该患者发生了3次气胸，1次发生在右侧，2次发生在左侧。患者的气胸发生率与开始使用CPAP存在时间关联。第三次发生气胸后，她永久性停用了CPAP治疗。通过本病例报告，我们强调了使用CPAP治疗OSA时发生气压伤的风险。与NPPV治疗OSA相关的PTX报道病例非常少。肺保护性通气策略以及限制气道正压可有助于降低CPAP导致肺气压伤的风险。
