Kumar Avnee J, Hjelmaas Alexander, Singer Benjamin H
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA.
Respir Med Case Rep. 2022 Oct 27;40:101755. doi: 10.1016/j.rmcr.2022.101755. eCollection 2022.
There is a growing population of patients who require chronic noninvasive ventilation. While these patients often have no parenchymal lung disease, the use of positive pressure ventilation itself predisposes to both initial and recurrent pneumothoraces. Furthermore, generally accepted pneumothorax management strategies, such as removing a chest tube after liberation from positive pressure ventilation, are not possible in this population. Despite this, there is a lack of clear guidance on management of pneumothorax in the chronically ventilated patient. In this case series, we discuss the management of pneumothoraces in patients requiring chronic noninvasive mechanical ventilation in our Assisted Ventilation Clinic (AVC). Our experience suggests a potential role of definitive treatment of the initial pneumothorax to prevent reoccurrence.
需要长期无创通气的患者群体正在不断扩大。虽然这些患者通常没有实质性肺部疾病，但使用正压通气本身会增加初次和复发性气胸的风险。此外，对于这类患者，一般公认的气胸处理策略，如在脱离正压通气后拔除胸腔引流管，是不可行的。尽管如此，对于长期通气患者气胸的处理仍缺乏明确的指导。在本病例系列中，我们讨论了在我们的辅助通气诊所（AVC）中，需要长期无创机械通气的患者气胸的处理。我们的经验表明，对初次气胸进行确定性治疗可能有助于预防复发。
