Chest Tube Insertion Following a Failed Needle Decompression in a Patient with Tension Pneumothorax: a Case ReportChest tube insertion following a failed needle decompression in a patient with tension pneumothorax: A case report
Abstract
Pneumothorax occurs when the pleural space is filled with air due to trauma, iatrogenic injury, or underlying lung disease. If this air leak forms a one-way valve that causes air to be trapped, an uncontrolled increase in air volume can occur, causing lung collapse and shift of the mediastinum to the contralateral side, which can eventually cause respiratory and hemodynamic disturbances or even death. Here, we report a 46-year-old male patient who came to the hospital complaining of shortness of breath and chest pain radiating to the left shoulder. On physical examination, the patient had severe shortness of breath, tracheal deviation, decreased expansion and air entry of the left hemithorax, hyperresonance of the left hemithorax, and a shift of the punctum maximum of the heart sounds to the left sternal line. The chest x-ray performed on the patient confirmed the suspicion of a tension pneumothorax. A needle decompression in the 2nd intercostal space in the left midclavicular line failed to improve the tension pneumothorax. A chest tube insertion was performed which managed to improve the patient's clinical condition.
References
Al Dameh, A. O., Lebenthal, A., & McNamee, C. J. (2015). Techniques for Pleural Drainage and Chest Tube Management. In D. J. Sugarbaker, R. Bueno, Y. L. Colson, M. T. Jaklitsch, M. J. Krasna, & S. J. Mentzer (Eds.), Adult Chest Surgery (2nd ed., pp. 79–84). New York: McGraw-Hill Education.
Alghnam, S., Aldahnim, M. H., Aldebasi, M. H., Towhari, J. A., Alghamdi, A. S., Alharbi, A. A., … Albabtain, I. T. (2020). The incidence and predictors of pneumothorax among trauma patients in Saudi Arabia Findings from a level-I trauma center. Saudi Medical Journal, 41(3), 247–252.
American College of Surgeons Committee on Trauma. (2018). Advanced Trauma Life Support Student Course Manual (10th ed.). Chicago, IL: American College of Surgeons.
Anderson, D., Chen, S. A., Godoy, L. A., Brown, L. M., & Cooke, D. T. (2022). Comprehensive Review of Chest Tube Management: A Review. JAMA Surgery, 157(3), 269–274.
Azizi, N., ter Avest, E., Hoek, A. E., Admiraal-van de Pas, Y., Buizert, P. J., Peijs, D. R., … ter Maaten, J. C. (2021). Optimal anatomical location for needle chest decompression for tension pneumothorax: A multicenter prospective cohort study. Injury, 52(2), 213–218.
Cheng, Y. L., Huang, T. W., Lin, C. K., Lee, S. C., Tzao, C., Chen, J. C., & Chang, H. (2009). The impact of smoking in primary spontaneous pneumothorax. Journal of Thoracic and Cardiovascular Surgery, 138(1), 192–195.
Chong, I. D., Chao, A., Hunter-Behrend, M., Gharahbaghian, L., Mitarai, T., Williams, S., & Perera, P. (2016). Diagnosis and Management of Spontaneous Pneumothorax in the Emergency Department: A Review of the Most Current Clinical Evidence for Diagnosis and Treatment. Pulmonary Research and Respiratory Medicine - Open Journal, 3(2), 23–29.
Dogrul, B. N., Kiliccalan, I., Asci, E. S., & Peker, S. C. (2020). Blunt trauma related chest wall and pulmonary injuries: An overview. Chinese Journal of Traumatology - English Edition, 23(3), 125–138.
Dural, K., Gulbahar, G., Kocer, B., & Sakinci, U. (2010). A novel and safe technique in closed tube thoracostomy. Journal of Cardiothoracic Surgery, 5(1), 5–8.
Fontaine, E. J., & Page, R. D. (2011). Pneumothorax and insertion of a chest drain. Surgery, 29(5), 244–246.
Kaserer, A., Stein, P., Simmen, H. P., Spahn, D. R., & Neuhaus, V. (2017). Failure rate of prehospital chest decompression after severe thoracic trauma. American Journal of Emergency Medicine, 35(3), 469–474.
Kuhajda, I., Zarogoulidis, K., Kougioumtzi, I., Huang, H., Li, Q., Dryllis, G., … Zarogoulidis, P. (2014). Tube thoracostomy; chest tube implantation and follow up. Journal of Thoracic Disease, 6(Suppl 4), S470-9.
Leech, C., Porter, K., Steyn, R., Laird, C., Virgo, I., Bowman, R., & Cooper, D. (2017). The pre-hospital management of life-threatening chest injuries: A consensus statement from the Faculty of Pre-Hospital Care, Royal College of Surgeons of Edinburgh. Trauma (United Kingdom), 19(1), 54–62.
MacDuff, A., Arnold, A., & Harvey, J. (2010). Management of spontaneous pneumothorax: British Thoracic Society pleural disease guideline 2010. Thorax, 65(SUPPL. 2).
No, M. Y., Moon, S. H., & Kim, H. S. (2012). Contralateral Tension Pneumothorax during One Lung Ventilation by a Univent® Tube. Yeungnam University Journal of Medicine, 29(1), 31.
Ortner, C. M., Ruetzler, K., Schaumann, N., Lorenz, V., Schellongowski, P., Schuster, E., … Frass, M. (2012). Evaluation of performance of two different chest tubes with either a sharp or a blunt tip for thoracostomy in 100 human cadavers. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 20(1), 10.
Ritchie, M., Brown, C., & Bowling, M. (2017). Chest tubes: Indications, sizing, placement, and management. Clinical Pulmonary Medicine, 24(1), 37–53.
Roberts, D. J., Leigh-Smith, S., Faris, P. D., Blackmore, C., Ball, C. G., Robertson, H. L., … Stelfox, H. T. (2015). Clinical presentation of patients with tension pneumothorax: A systematic review. Annals of Surgery, 261(6), 1068–1078.
Sahota, R. J., & Sayad, E. (2022). Tension Pneumothorax. In StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing.
Santry, H. P., & Simon, B. J. (2013). Hemothorax, Pneumothorax, and Empyema. In L. J. Moore, K. L. Turner, & S. R. Todd (Eds.), Common Problems in Acute Care Surgery (pp. 1–527). Cham (SW): Springer International Publishing.
Sharma, A., & Jindal, P. (2008). Principles of diagnosis and management of traumatic pneumothorax. J Emerg Trauma Shock, 1(1), 34–41.
Stawicki, S. A., Kwiatt, M., Tarbox, A., Seamon, M., Swaroop, M., Cipolla, J., … Cook, C. (2014). Thoracostomy tubes: A comprehensive review of complications and related topics. International Journal of Critical Illness and Injury Science, 4(2), 142.
Yehia Elhariri, S., Mohamed, H., AS Burud, I., & Elhariri, A. (2019). Changing Trends in the Decompression of Tension Pneumothorax. Journal of Surgery and Research, 02(04), 261–266.
Zarogoulidis, P., Kioumis, I., Pitsiou, G., Porpodis, K., Lampaki, S., Papaiwannou, A., … Zarogoulidis, K. (2014). Pneumothorax: from definition to diagnosis and treatment. Journal of Thoracic Disease, 6(Suppl 4), S372-6.
Authors
Copyright (c) 2023 Nanang Salman Saleh, Gusti Ngurah P Pradnya Wisnu, Alim Muhaimin, Dea Tasha Meicita Kis Sugianto
This work is licensed under a Creative Commons Attribution 4.0 International License.
Qanun Medika by FK UM Surabaya is liscence under Lisensi Creative Commons Atribusi 4.0 Internasional.
