Heffner J E, McDonald J, Barbieri C
Department of Medicine, St. Joseph's Hospital and Medical Center, Phoenix, AZ 85001, USA.
Chest. 1995 Oct;108(4):1053-8. doi: 10.1378/chest.108.4.1053.
The incidence of recurrent pneumothoraces was analyzed in mechanically ventilated patients with the adult respiratory distress syndrome (ARDS) or non-ARDS causes of respiratory failure who had ipsilateral chest tubes in place. The radiographs of 39 consecutive patients with 47 initial pneumothoraces were evaluated for pneumothorax recurrence and chest tube positioning, which was prospectively defined as having a "vertical" or "horizontal" orientation. "Horizontal" positioning indicated that the chest tube may have been placed into a major fissure or the posterior hemithorax. Sixteen of the 47 pneumothoraces in all study patients, 14 of the 21 pneumothoraces in patients with ARDS, and 2 of the 26 pneumothoraces in patients without ARDS recurred (p < 0.0001) despite an ipsilateral chest tube; 9 of the 14 ARDS pneumothorax recurrences were tension types. "Horizontal" chest tube positioning in patients with ARDS had a positive predictive value of 86% and 64% for recurrences of pneumothoraces and tension pneumothoraces, respectively. Recurrent pneumothoraces occur commonly in mechanically ventilated patients with ARDS despite ipsilateral chest tubes. Because pneumothorax recurrences appear to be related to horizontal chest tube placement, imaging studies should verify that chest tubes are placed in optimally in the anterior hemithorax away from interlobar fissures in this patient population.
对患有成人呼吸窘迫综合征（ARDS）或因非ARDS导致呼吸衰竭且同侧放置胸管的机械通气患者复发性气胸的发生率进行了分析。对39例连续患者的47次初始气胸的X线片进行了气胸复发和胸管定位评估，胸管定位前瞻性地定义为“垂直”或“水平”方向。“水平”定位表明胸管可能已置入主裂或后胸腔。所有研究患者的47次气胸中，有16次复发；ARDS患者的21次气胸中，有14次复发；非ARDS患者的26次气胸中，有2次复发（p<0.0001），尽管放置了同侧胸管；14次ARDS气胸复发中有9次为张力性气胸。ARDS患者“水平”胸管定位对气胸复发和张力性气胸复发的阳性预测值分别为86%和64%。尽管有同侧胸管，复发性气胸仍常见于机械通气的ARDS患者。由于气胸复发似乎与胸管水平放置有关，影像学检查应证实该患者群体的胸管最佳放置位置是在前胸腔，远离叶间裂。
