Yadav Gopal Kumar, Keshari Bibek, Rohita Dipesh Kumar, Mandal Krishna Chandra, Bogati Sunil, Mishra Deebya Raj
Department of Internal Medicine, Kalaiya District Hospital, Bara, Nepal.
Department of Internal Medicine, B. P. Koirala Institute of Health Sciences, Dharan, Nepal.
Ann Med Surg (Lond). 2022 Jun 25;79:104064. doi: 10.1016/j.amsu.2022.104064. eCollection 2022 Jul.
and importance: We reported a case of secondary spontaneous pneumothorax (SSP) in a 70-years-old male with acute exacerbation of COPD (AE COPD) managed with improvised chest tube drain (ICD).
He presented with sudden onset breathlessness and oxygen saturation of 78%. With prolonged expiration on auscultation, he was treated as AE COPD with oxygen therapy, nebulization with albuterol/ipratropium, and injectable antibiotics and steroids. The patient was not improving with treatment on third day, and non-critical respiratory distress continued. Considering the alternative diagnosis, the chest X-ray was done which revealed right sided spontaneous pneumothorax and COPD. Due to his reluctancy to go to higher center for chest tube insertion during ongoing COVID-19 pandemic, we inserted ICD (intravenous set put in saline bottle) at our primary care. Following drainage, breathlessness improved and saturation increased. Then inpatient symptomatic treatment for COPD was continued for three more days. He was discharged on inhalers after fifth day and asked for follow up after 10 days. He came after 1 month and on repeat chest X-ray, his right sided pneumothorax resolved completely and COPD was in control with inhaled medications. There was no recurrence of pneumothorax in five months follow up.
ICD is a safe, and an alternative option in resource limited setting. However, the guidelines recommend chest tube insertion as appropriate treatment.
This would remind the physicians to anticipate the alternative possibility, and to re-examine those with AE COPD who are not improving as expected with oxygen and nebulization therapy.
及重要性：我们报告了一例70岁男性的继发性自发性气胸（SSP）病例，该患者因慢性阻塞性肺疾病急性加重（AE COPD）接受了简易胸腔闭式引流（ICD）治疗。
他因突发呼吸困难和氧饱和度78%就诊。听诊发现呼气延长，给予氧疗、沙丁胺醇/异丙托溴铵雾化、注射用抗生素和类固醇治疗，诊断为AE COPD。治疗第三天患者病情无改善，仍有非重症呼吸窘迫。考虑到其他诊断可能性，进行了胸部X线检查，结果显示右侧自发性气胸和COPD。由于在新冠疫情期间患者不愿前往上级医院进行胸腔置管，我们在基层医疗单位为其插入了ICD（将静脉输液器插入盐水瓶）。引流后，呼吸困难改善，饱和度增加。随后继续对COPD进行了三天的住院对症治疗。第五天患者出院时使用吸入器，并被要求在10天后进行随访。1个月后他前来复诊，复查胸部X线显示右侧气胸完全吸收，吸入药物可控制COPD。随访五个月气胸未复发。
在资源有限的情况下，ICD是一种安全的替代选择。然而，指南推荐胸腔置管作为合适的治疗方法。
这将提醒医生考虑其他可能性，并重新检查那些接受氧疗和雾化治疗后未如预期改善的AE COPD患者。
