Pneumothorax Of The Lung

2024 Author: Josephine Shorter | [email protected]. Last modified: 2024-01-07 17:49

Pneumothorax of the lung

Pneumothorax is a disease whose name comes from two Greek words - pneuma and thorax (air and chest). An acute condition, which occurs quite often today, is a concentration in the pleural cavity of air. The victim needs immediate medical attention.

Content:

• Causes of pneumothorax
• Pneumothorax symptoms
• Consequences of pneumothorax
• Emergency care for pneumothorax
• Treatment of pneumothorax

What is a pneumothorax of the lung?

Pneumothorax of the lung is a life-threatening pathology in which air enters where it should not normally be - into the pleural cavity.

Air, once in the pleural cavity, is capable of provoking a collapse of the lung, which has a full or partial form. The development of the disease can be spontaneous or occur in connection with lung diseases already present in a person, injuries, and medical manipulations. The ventilation function of the lungs is impaired, they are compressed, there is an oxygen deficiency, respiratory failure. The organs of the mediastinum (large vessels, heart) are displaced, there are failures of the blood circulation processes.

What are the types of pneumothorax?

The presence / absence of connection with the environment divides the disease into the following types:

• Open. Depressurization of the respiratory system occurs. Through the opening in the chest, air seeps into the pleural cavity during inhalation, leaves it during exhalation, its accumulation does not happen. The pressure, which has ceased to be negative, leads to the fact that the lung collapses, ceases to participate in the respiratory process, gas exchange in it stops, the supply of oxygen to the blood stops.
• Closed. A certain amount of gas appears in the pleural cavity, its volume remains stable, since the acquired defect closes quickly. If the air leaves the cavity on its own (which is very likely with a closed wound), the compressed lung is leveled, and respiratory processes are normalized. This variety is ranked among the lightest.
• Valve. Displacement of the mediastinal organs, malfunctions of their functioning, pleuropulmonary shock - all these are the dangers that threaten the patient with this form of the disease, which is called the most severe. The emergence of the valve structure leads to the fact that the air is concentrated in the pleural cavity without leaving it, the pressure builds up. Air enters through the wound.

Depending on whether complications join, the following types of disease are called.

• Uncomplicated. Complications do not develop as a result of illness.
• Complicated. Complications are added: emphysema, bleeding, pleurisy, and so on.

Depending on the type of spread, pneumothorax can be unilateral or bilateral:

• Unilateral. The patient has a collapse of one lung - left or right.
• Bilateral. The patient has a constriction of both lungs. This pathological condition is a serious threat to life, the patient needs emergency help.

In addition, pneumothorax in terms of air volume can be complete, parietal, enclosed.

• Full. In this case, the lung collapses completely. If the patient has complete bilateral pneumothorax, he needs urgent help. Otherwise, a critical failure of the respiratory function can be fatal.
• Parietal. A small amount of air fills the pleural cavity, the lung is not fully expanded. (This is mostly a closed form).

• Encapsulated. The adhesions between the parietal and visceral pleura limit the area of the pneumothorax. Sometimes there are no symptoms, the species does not pose a particular danger, but theoretically it can cause ruptures of lung tissue in the adhesion zone.

Pneumothorax in all its manifestations is not a purely "adult" problem, even babies who have just been born face the disease. In young children, the disease can form for many reasons, causes a number of unique symptoms, but doctors fight it in the same way as they treat adults.

Causes of pneumothorax

Iatrogenic, traumatic, spontaneous - these are the main groups of reasons why a patient may develop this pathology.

Spontaneous pneumothorax

A pathology in which there is a sudden violation of the integrity of the pleura, filling its cavity with air. In this case, the patient does not receive external injuries. Depending on the cause, it can be primary or secondary.

The occurrence of a primary pneumothorax has no obvious reasons. High growth, male, 20-30 years old, the presence of bad habits (cigarettes) - these are the main risk factors. It is extremely rare for the disease to occur after 40 years, and women are also less likely to suffer from it.

The following diseases and pathologies can give rise to spontaneous pneumothorax:

• genetically determined weakness of the pleura, in which laughter, a coughing fit, physical exertion are enough to rupture it;
• congenital lack of the enzyme alpha-1-antitrypsin, which causes pathological processes in the lungs;
• travel by plane (pressure drops), diving, diving.

Secondary spontaneous pneumothorax develops in connection with pulmonary pathology. It can be:

• lung diseases that injure connective tissue (sarcoidosis, lymphangioleiomyomatosis, idiopathic pneumosclerosis, tuberous sclerosis);
• malignant neoplasms (lung cancer, sarcoma);
• respiratory tract diseases (cystic fibrosis, severe bronchial asthma, COPD);
• infectious lung diseases (lung abscess, tuberculosis, pneumonia with HIV);
• systemic connective tissue diseases, including lung damage (dermatomyositis, rheumatoid arthritis, systemic scleroderma, polymyositis, Marfan syndrome).

In most cases, this disease is encountered in old age - 60-65 years.

Iatrogenic pneumothorax

The main source of this form is various medical manipulations. The disease can be activated by:

• installation of a venous (central) catheter;
• ventilation of the lungs;
• biopsy of the pleura;
• puncture of the pleural cavity;
• cardiopulmonary resuscitation.

Traumatic pneumothorax

Injuries, chest trauma are the main source of this form of the disease:

• a closed chest injury resulting from a fall from a height, a fight, and so on (traumatic rupture of the lung, damage by pieces of broken ribs without violating the integrity of the skin);
• penetrating chest wound (gunshot, stab wounds causing rupture of the lungs).

Pneumothorax in newborns

Pneumothorax is an anomaly that often occurs in young children, newborn babies.

The causes of pneumothorax in childhood can be as follows.

• Intense crying leads to rupture of the pleural adhesion.
• Rupture of an acquired or congenital cyst.
• Pulmonary forced ventilation.
• Genetic pathology of the lungs causes rupture of the emphysematous alveoli.
• Lung abscess rupture.

The most common occurrence of this disease in a child is associated with genetic deformities of the lungs and pleura (irregular structure), trauma and inflammatory processes. Sometimes birth asphyxia becomes an activating factor, rupture of the tissue of the baby's lung occurs with forced artificial respiration. Pneumothorax can also occur as a result of clogging of the airways by amniotic fluid or mucus.

Pneumothorax symptoms

Pneumothorax can manifest itself with the following symptoms, their appearance depends on the specific type of disease, the severity of its course, the presence / absence of complications and other factors.

• Sudden onset of shortness of breath - the patient has shallow rapid breathing, it is difficult for him to breathe.
• Sharp pain in the chest area - activated by inhalation, acute; also possible kickback to the shoulder from the injured side.
• Dry cough attacks.
• The patient takes a forced posture (half-sitting, sitting).
• Feeling of weakness, fear, increased heart rate, decreased blood pressure.
• The appearance of sticky cold sweat on the skin.
• Subcutaneous emphysema - when you exhale, air enters the subcutaneous fat, when you press the swelling, a noise similar to the crunch of snow appears.
• Blueness of the skin - a symptom occurs with pronounced failures in the processes of blood circulation, respiration.
• Discharge of "foamed" blood from the wound (with open pneumothorax).

Symptoms of spontaneous pneumothorax

Almost all patients diagnosed with spontaneous primary pneumothorax tell doctors about chest pain manifested from the side of the defect, about sudden shortness of breath. The intensity of pain varies from very strong to minimal. Most patients describe it first as acute, and then as dull or aching. The clinical picture lasts no more than a day, regardless of whether the disease is being treated.

If a patient has a spontaneous secondary pneumothorax, he will certainly have shortness of breath, regardless of how much air is in the pleural cavity. Most often, pain appears, localized on the affected side. Probably the addition of hypoxemia, hypotension.

Symptoms of valvular pneumothorax

The patient is in an agitated state, complains of a sharp pain in the chest. Painful sensations can have a stabbing or dagger character, give to the scapula, shoulder, abdominal cavity. Weakness, cyanosis, shortness of breath develop instantly, fainting is quite likely.

Symptoms of pneumothorax in infants

The symptoms of pneumothorax in babies under one year old may look like this:

• the appearance of puffiness of the face;
• tachycardia;
• cyanosis of the skin;
• anxiety, agitation;
• difficulty breathing, shortness of breath;
• the occurrence of subcutaneous crepitus on the trunk, neck.

Consequences of pneumothorax

Complications of pneumothorax, according to statistics, are observed in approximately 50% of patients.

• Inflammation of the pleura (pleurisy). May be accompanied by the appearance of adhesions that disrupt the expansion of the lung.
• Air penetration into the tissue of the mediastinum, constriction of large vessels, heart.
• Intrapleural bleeding.
• Subcutaneous emphysema is a condition in which air is trapped in the subcutaneous fat.
• Fatal outcome. Possible in severe cases - a penetrating chest wound, a large amount of damage.

Emergency care for pneumothorax

Pneumothorax in valvular or open form is one of the emergency conditions, in the event of which an ambulance must be called immediately. Then you should definitely do the following:

• stop the process of filling the victim's pleural cavity with air;
• stop bleeding.

You will need to apply a tight, sealed bandage. In an emergency, in the absence of sterile means, you need to use improvised things - a shirt, a T-shirt. The cleanest area is applied to the wound. To seal the wound, a plastic bag (oilcloth, film) is applied over an impromptu bandage.

You should also simplify the patient's breathing process, for which he needs to be placed in an elevated position. All actions are performed with extreme caution, as they cause additional pain to the victim. If a person faints, be sure to bring him to his senses. If there is no ammonia at hand, any product with a pungent smell will do, for example, gasoline, perfume, nail polish remover. The product is brought to the nose.

The last task is to prevent the development of pain shock, banal aspirin or analgin will help with this. After providing first aid, you should wait for the arrival of an ambulance.

Treatment of pneumothorax

Pneumothorax is life threatening, so the treatment process begins even before arriving at the hospital.

On the way to the hospital

• Anesthesia. If the patient is worried about excruciating pain, he is injected with narcotic analgesics - omnopon, morphine. If there are no pronounced pains, analgin can be dispensed with.
• Oxygen therapy.
• Removal of the cough reflex. To get rid of the patient from coughing attacks, antitussive drugs are used - libexin, codeine, tusuprex.
• Pleural puncture. This procedure becomes necessary if the patient's condition deteriorates sharply (rapid drop in blood pressure, increased shortness of breath), which is caused by valvular pneumothorax. The puncture can be done not only by a doctor, but also by a paramedic.

Inpatient treatment

Patients with pneumothorax are subject to compulsory hospitalization. Medical assistance consists in puncture of the pleural cavity, removal of air, and the formation of negative pressure in the pleural cavity. Treatment depends on the form of the disease.

Conservative expectant therapy is relevant when it comes to closed limited small pneumothorax. The patient is provided with rest, pain relievers are administered. If necessary, air is aspirated using a puncture system. Pleural puncture is done on the side of the injury along the midclavicular line in the second intercostal space.

In the case of a total form, to prevent a shock reaction and rapid expansion of the lung, drainage is placed into the pleural cavity, followed by active (using an electric vacuum device) or passive (according to Bulau) air aspiration.

The first task with an open pneumothorax is to transfer it to a closed one. For this, the wound is sutured, the penetration of air into the pleural cavity stops. This is followed by manipulations similar to those carried out with a closed form.

If the victim has valvular pneumothorax, a decrease in pressure inside the pleura is required. It is first made open by puncture, followed by surgical treatment.

Spontaneous recurrent pneumothorax, provoked by bullous emphysema, is treated with surgery.

Anesthesia

Pain relief is an important point in the fight against pneumothorax, pain relievers are required for the patient both at the stage of lung collapse and during its expansion. In order to prevent relapses of the disease, pleurodesis is carried out with silver nitrate, talc, glucose solution and other sclerosing drugs. So in the pleural cavity the adhesive process is deliberately stimulated.

Rehabilitation and prevention

After leaving the hospital, a patient who has suffered pneumothorax should refrain from any physical activity for 3-4 weeks. Airplane flights are prohibited for 2 weeks after treatment. You should not go in for skydiving, diving - all this causes pressure drops. It is strictly forbidden to smoke, you should definitely quit this dangerous habit. Doctors also advise to be screened for tuberculosis, COPD.

Unfortunately, there are no preventive methods that can turn into reliable protection against pneumothorax, but some actions are still worth taking:

• To give up smoking.
• Examination for lung diseases, their timely treatment.
• Spend enough time outdoors.
• Breathing exercises.

Pneumothorax is not a verdict at all, most of the sick successfully cope with it. Uncomplicated forms of the disease, with their timely treatment, guarantee a successful outcome, but not the absence of the danger of relapse.

According to statistics, primary spontaneous pneumothorax returns to a person in about 30% of cases, most often it occurs in the first six months after treatment. Relapse rates in the case of secondary spontaneous pneumothorax are even higher - up to 47%.

The sooner a patient who shows signs of pneumothorax is taken to the hospital, the more chances he has for a successful recovery.

Author of the article: Alekseeva Maria Yurievna | Therapist

Education: From 2010 to 2016 Practitioner of the therapeutic hospital of the central medical-sanitary unit No. 21, city of elektrostal. Since 2016 she has been working in the diagnostic center No. 3.