Thachuthara-George Joseph
Interventional Pulmonary Program, Division of Pulmonary, Allergy, and Critical Care Medicine, UAB, The University of Alabama at Birmingham, Birmingham, AL, USA.
J Thorac Dis. 2021 Aug;13(8):5195-5204. doi: 10.21037/jtd-19-3752.
Pneumothorax is not an uncommon occurrence in ICU patients. Barotrauma and iatrogenesis remain the most common causes for pneumothorax in critically ill patients. Patients with underlying lung disease are more prone to develop pneumothorax, especially if they require positive pressure ventilation. A timely diagnosis of pneumothorax is critical as it may evolve into tension physiology. Most occurrences of pneumothoraces are readily diagnosed with a chest X-ray. Tension pneumothorax is a medical emergency, and managed with immediate needle decompression followed by tube thoracostomy. A computed tomography (CT) scan of the chest remains the gold standard for diagnosis; however, getting a CT scan of the chest in a critically ill patient can be challenging. The use of thoracic ultrasound has been emerging and is proven to be superior to chest X-ray in making a diagnosis. The possibility of occult pneumothorax in patients with thoracoabdominal blunt trauma should be kept in mind. Patients with pneumothorax in the ICU should be managed with a tube thoracostomy if they are symptomatic or on mechanical ventilation. The current guidelines recommend a small-bore chest tube as the first line management of pneumothorax. In patients with persistent air leak or whose lungs do not re-expand, a thoracic surgery consultation is recommended. In non-surgical candidates, bronchoscopic interventions or autologous blood patch are other options.
气胸在重症监护病房（ICU）患者中并不罕见。气压伤和医源性因素仍然是重症患者气胸最常见的原因。患有基础肺部疾病的患者更容易发生气胸，尤其是在需要正压通气的情况下。及时诊断气胸至关重要，因为它可能演变为张力性生理状态。大多数气胸病例通过胸部X线检查很容易诊断出来。张力性气胸是一种医疗急症，需立即进行针减压，随后进行胸腔闭式引流术。胸部计算机断层扫描（CT）仍然是诊断的金标准；然而，对重症患者进行胸部CT扫描可能具有挑战性。胸部超声的应用正在兴起，并且已被证明在诊断方面优于胸部X线检查。应牢记胸腹钝性创伤患者发生隐匿性气胸的可能性。ICU中的气胸患者如果有症状或正在接受机械通气，应进行胸腔闭式引流术治疗。当前指南推荐使用细胸管作为气胸的一线治疗方法。对于持续漏气或肺部未复张的患者，建议咨询胸外科。对于不适合手术的患者，支气管镜干预或自体血补片是其他选择。
