Iatrogenic pneumothorax that occurred during interventional procedures: literature review

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Kraujelytė Agnė1

1Faculty of Medicine, Vilnius University, Vilnius, Lithuania

Abstract

Background. Pneumothorax – a condition in which there is air in the pleural cavity, it can be spontaneous (primary), secondary and iatrogenic. During invasive procedures, such as lung tissue biopsy (transthoracic or transbronchial), insertion of a central venous catheter, or positive pressure ventilation, iatrogenic pneumothorax is a complication of these procedures. This literature review summarizes the pathophysiological mechanisms of iatrogenic pneumothorax, the symptoms that need to be addressed in various interventions near lung tissue, treatment options, and recommendations to reduce the incidence of iatrogenic pneumothorax and increase the safety of invasive procedures.

Aim: to review the literature on the diagnostics and treatment of iatrogenic pneumothorax.

Methods. Literature analysis was performed using keywords: iatrogenic pneumothorax, pneumothorax treatment, pneumothorax during invasive procedures. The literature review is described in evidence-based medicine, using the PubMed archive of scientific publications, with priority given to content with the highest level of evidence. The Zotero bibliography storage and management program was used to archive and manage literature sources.

Results and conclusions. Using theoretical analysis methods, 65 publications meeting the inclusion criteria were found. 36 publications were excluded because did not meet the inclusion criteria. Iatrogenic pneumothorax usually occurs (32-37% of cases) by lung tissue biopsy, insertion of a central venous catheter, during positive pressure ventilation. The risk of developing a complication is greatly increased when a postoperative central venous catheter is inserted outside of ultrasound control. The primary symptoms of iatrogenic pneumothorax are pleuritic pain, dyspnea, tachypnea, and tachycardia. Confirmation of the diagnosis is based on clinical manifestation and ultrasound examination. In the case of iatrogenic pneumothorax, treatment is preferred to visualization. Treatment options include needle insertion during thoracostomy or surgical interventions.

Keywords: iatrogenic pneumothorax, pneumothorax treatment, pneumothorax during invasive procedures.