Pneumothorax - what it is, why it is dangerous and how to provide emergency care. Pulmonary pneumothorax: types, symptoms, emergency care

Pneumothorax is the accumulation of gas in the pleural cavity, resulting in prolapse of lung tissue with displacement of the mediastinum. This in turn leads to compression of large blood vessels mediastinum, circulatory disorders and respiratory dysfunction.

The air in the lungs penetrates through the cavity that has formed there in a series of various reasons. Often during pneumothorax, the victim’s life is in danger. To seek timely medical help, you should be able to recognize the first signs of this disease.

Reasons for the development of the disease

Pneumothorax of the lung is a condition of the respiratory system that can occur due to many provoking factors. The disease develops due to two main reasons: mechanical damage chest, as well as the presence of certain diseases that destroy lung tissue. In the second case, the patient must know the first signs of lung destruction.

Possible causes of the disease:

chest injuries (open, penetrating and closed, which are accompanied by rib fractures);
damage to the lung during certain medical procedures (puncture pleural cavity, installation of a subclavian catheter, etc.);
some organ diseases respiratory system(tuberculosis, abscess, emphysema);
spontaneous rupture of the esophagus (Boerhaave syndrome);
features of the body that imply underdevelopment of the pleural petals.

Sometimes during medical practice the method of applying an artificial pneumothorax is used.

This method allows you to stop pulmonary bleeding and helps cure some forms of tuberculosis. As a rule, the treatment is long-term and the patient knows in advance about the method by which the therapy is carried out.

Classification

There are different types of pneumothorax, which are divided into classifications based on the causes of their occurrence, location and extent of the lesion. Depending on how much the lung tissue and pleura are damaged, the pulmonologist prescribes a treatment plan and announces a prognosis.

Depending on the scale of damage to the lung tissue, there are:

Total pneumothorax (complete). It is characterized by complete compression of the lung due to the release of a large amount of gas into the pleural cavity.
Limited pneumothorax (partial). The collapse of the respiratory organ is incomplete.

If the lesion is on the left side, left-sided pneumothorax is diagnosed, on the right lung - right-sided pneumothorax. There is also a bilateral type of disease, which develops due to total compression of two lungs at the same time and is fraught with the rapid death of the victim.

The disease is also divided according to its causes:

Traumatic pneumothorax. This option is possible if the chest is damaged. It develops as a result of a penetrating wound (for example, a knife wound), as well as due to injury to the lung tissue by a fragment of a rib during an open or closed fracture.
Spontaneous. Occurs due to rapid rupture of lung tissue against the background of a chronic disease or predisposing factors. Thus, the cause of primary (idiopathic) pneumothorax can be congenital deficiency pleural tissue, strong laughter or sharp cough, rapid diving to depth, as well as flying on an airplane. Secondary develops due to severe lung diseases.
Artificial. It is created intentionally under the supervision of a competent specialist for the treatment of certain respiratory diseases.

Pneumothorax can be complicated by various pathologies or occur without them. The clinical picture of the disease also depends on the amount of air entering the pleural cavity and its circulation in the wound.

According to the communication with air from the environment:

Closed. A one-time entry of a small amount of air into the pleural cavity occurs, after which its volume no longer changes.
Open. There is a visual defect in the sternum, through which, with each inhalation, air enters the cavity, and with exhalation, it exits. The process may be accompanied by audible squelching and gurgling.
Valve. Has the most severe consequences. During a tension pneumothorax, with each inspiration, air enters the peripulmonary space, but there is no escape of it out.

Each of the conditions, regardless of severity, requires a thorough examination by a doctor and proper treatment. This will help minimize the risk of relapse, and in some cases save the life of the victim.

Symptoms

Signs of pneumothorax are quite difficult to miss. The clinical picture differs in severity, signs may be observed oxygen starvation, as well as the consequences of circulatory disorders that occur due to compression of the mediastinum.

Symptoms of pneumothorax:

pain in the affected area of a stabbing nature, which can radiate to the arm, back, neck;
painful sensations increase significantly during movement, coughing, talking, sneezing;
fear of death caused by severe pain and the inability to take a full breath;
the victim takes a forced position;
shortness of breath, less often – dry cough;
swelling of the neck veins;
pallor and then cyanosis (blue discoloration) skin;
disturbance of heart rhythm, signs of arrhythmia;
if the pneumothorax is open, you can visually observe air entering the wound, then foamy blood is released from it.

Depending on the location and extent of the lesion, symptoms may be weakened. After a few hours, the symptoms weaken significantly, pain and shortness of breath appear only during bodily movements. Sometimes emphysema develops, which is the release of accumulated air under the skin.

After a few hours, inflammation of the pleura develops. The clinical picture differs in severity if damage to lung tissue occurs by more than 40%.

The accumulation of air in the pleural cavity is a life-threatening and health-threatening condition, therefore, when the first signs of the disease appear, you should immediately seek medical help. It is especially necessary to monitor your well-being for those patients who suffer from chronic diseases of the pulmonary and digestive systems.

Diagnostics

Pneumothorax of the lungs is determined by a comprehensive diagnostic method, which includes a survey and examination of the victim, as well as X-rays and puncture of the lungs, if necessary.

Laboratory blood tests, as a rule, do not clarify the clinical picture. In the analyzes it is possible to trace the dynamics of the concomitant disease that contributed to the rupture lung tissue. Hypoxemia (accumulation of foreign gases in it) may be observed in arterial blood.

Survey

To correctly assess the condition of the victim, the pulmonologist needs to conduct a thorough interview.. This will help identify the causes of pneumothorax and prescribe the correct treatment.

At the initial visit, a complete life history is collected and specific disease, during a return visit to the doctor, the patient answers questions that relate exclusively to the disease.

What a specialist needs to know to make a diagnosis:

the presence of any chronic diseases;
what symptoms of the disease are present;
when and why the pain appeared, its nature, intensity;
whether there has been a recent blow, fall or other mechanical impact that could cause compression of the lung.

It is necessary to answer the doctor’s questions as thoroughly and quickly as possible; you should not remain silent about existing diseases. If you are allergic to any medical supplies, we need to talk about this medical personnel. After the interview, an examination and additional examinations are carried out.

Inspection

The patient's position can be visually assessed. As a rule, it is forced, on the side in which the lung prolapse occurred. If the wound is open, the specialist notes its size and the presence of foam in the blood. During auscultation, breathing is practically not audible on the affected side.

The pulmonologist also evaluates the nature of shortness of breath, which during pneumothorax is frequent, superficial. Percussion of the affected side produces a boxed sound (dull, hollow). The excursion of the chest on the side where the pneumothorax occurred is slightly behind the healthy one.

Radiography

On x-rays you can observe a large light area, which is located on the affected side. The pulmonary pattern is not visible. There is a clear boundary between healthy and damaged lungs. A displacement of the mediastinum is visually noticeable, the dome of the diaphragm is lowered.

Pleural puncture

It is performed under local anesthesia using a hollow needle, which is inserted into the intercostal space from the back. During the procedure, all accumulated air is removed, after which the nature of the contents of the pleural cavity is clarified in the laboratory.

The biomaterial is also sent for bacteriological testing, cytological examination. IN severe cases, if the puncture does not alleviate the victim’s condition, medical indications Thoracoscopy is performed.

Treatment

A person who does not have sufficient knowledge in medical field, carry out the necessary therapeutic measures and it will be difficult to provide first aid to the victim. Therefore, it is better to entrust the evacuation of accumulated air to professionals.

There are no treatment methods that provide a 100% guarantee against recurrence of the pathology. Therefore, therapy has 3 goals: eliminate the cause, resolve pneumothorax in a particular case, and prevent the likelihood of relapse.

Oxygen therapy

Medical observation without any serious interventions is indicated in the case of non-extensive pneumothorax, when tissue damage is no more than 15%. In such cases, spontaneous resorption of air from the cavity is possible, which takes about 1-2 weeks.

Oxygen therapy is indicated for all patients suffering from prolapse of lung tissue. The procedure helps the body recover faster and reduces the risk of complications. In patients with a history of COPD or other chronic diseases, it is necessary to monitor the concentration of gases in the blood.

Aspiration of the contents of the pleural cavity

Evacuation of the contents of the cavity is performed using a catheter or hollow needle. The procedure is carried out by a competent specialist, since a non-professional is able to pierce an artery and some vital organs. In one session, it is allowed to remove no more than 4 liters of air. This should be done gradually to prevent mediastinal shift.

If symptoms remain several hours after aspiration and respiratory functions are not restored, installation of a drainage system is indicated.

Indications for the procedure:

multiple relapses of the disease;
age over 50 years;
lack of success with aspiration.

A special drainage tube is installed in the intercostal space, which helps remove excess air.. An air or water lock is attached to the end. In the second case, it is possible to track the smallest gas leak, which is why this technique is more popular. Removal of the drainage occurs one day after the complete cessation of the passage of air masses, if radiography confirms expansion of the lung.

Introduction of special substances into the pleural cavity (chemical pleurodesis)

This procedure carried out to prevent possible relapses if their likelihood is high enough. To do this, special substances are introduced into the pleural cavity that promote its obliteration, that is, the fusion of the pleural layers with each other. Administration is carried out through the drainage system. Chemical pleurodesis helps to minimize the risks of recurrence of the disease to almost zero.

Surgical intervention

The operation is performed when it is impossible to use alternative methods treatments or their ineffectiveness. In this case, thoracotomy or thoracoscopy is performed. Surgery is the most effective method combating pneumothorax and its further relapses.

When it is carried out:

the lung tissue does not straighten out a week after drainage;
spontaneous bilateral pneumothorax;
relapse occurs after chemical pleurodesis;
if the victim received the disease due to a certain profession (pilot, diver, etc.);
complicated pneumothorax.

The decision to carry out the operation is made by the commission, analyzing all previous actions of the medical staff and studying the victim’s tests. Intervention is also carried out if the cause of the disease is open wound. It is sutured, after which the patient is observed and necessary measures for the treatment of pneumothorax of the lung.

Prevention, possible complications, prognosis

The concept of pneumothorax is familiar to many people suffering from other chronic lung diseases. It is a serious complication that, if not properly treated, can lead to the death of the victim.

The most favorable prognosis is if tissue damage is no more than 15%. The most critical conditions are diagnosed in the case of spontaneous bilateral pneumothorax. The success of treatment depends on the speed of contacting a doctor and subsequent resuscitation measures.

What can be done for prevention:

stop smoking;
treat accompanying illnesses lungs, digestive tract;
visit a pulmonologist once every six months, especially if shortness of breath occurs;
lead healthy image life;
limit the number of air travel;
do not dive into depth.

As a rule, pneumothorax does not occur without any reason. If a person is attentive to his health, undergoes preventive examinations in a timely manner and, at the slightest sign of deterioration, consults a doctor, the risk of serious illnesses is reduced significantly.

Pneumothorax is a condition in which air accumulates between the lung and the chest wall. The lungs can be thought of as a balloon that is placed in a vacuum. When air enters the pleural cavity, the mediastinal organs begin to shift to the contralateral side. When the pressure in the pleural cavity rises above atmospheric pressure, the lung collapses completely.

Pneumothorax of the lung can occur spontaneously, even when a person does not suffer from lung disease, in which case a primary pneumothorax develops, if there is a pulmonary disease, a “secondary” condition is formed.

The causes of pneumothorax can be divided into 2 groups:

Mechanical injuries of the chest and lungs:

Open and closed injuries;
Complications of diagnostic and treatment procedures, for example, insertion of a catheter and puncture;
Artificially induced pneumothorax ( this state can be artificially induced for the purpose of diagnosing and treating tuberculosis).

Diseases of the chest cavity and lungs:

of a specific nature;
non-specific nature

Pneumothorax, the causes of which can be different, requires prompt and effective treatment.

Types of disease

Depending on the origin, the volume of air contained, the method of spread of the disease, the presence of complications, contact with external environment, there are different types of pneumothorax:

By origin:

Traumatic. Becomes a consequence of closed (without damaging the integrity of the skin) and open (knife, gunshot wounds) injuries that lead to rupture of the lungs;
Spontaneous pneumothorax. Forms suddenly due to a violation of the integrity of the lung. This type of pneumothorax can be primary, secondary or recurrent;
Artificial. Formed when air is artificially introduced into the pleural cavity for the purpose of therapeutic diagnosis

According to the volume of air contained in the pleural cavity:

Limited. With this type pneumothorax lung does not subside completely;
Complete or total. With this type of pneumothorax, the lung is completely compressed

By distribution type:

Unilateral. Characterized by collapse of either the right or left lung;
Bilateral. Characterized by compression of both lungs. This condition is critical and can be fatal.

According to the presence of complications

Complicated pneumothorax of the lungs. This type is accompanied by bleeding, emphysema and;
Uncomplicated. Not accompanied by complications

Depending on the communication with the external environment:

Closed pneumothorax is a condition in which the pleural cavity does not communicate with the environment. With this form of the disease, the amount of gas does not increase. Closed pneumothorax is characterized by the mildest course, while a small amount of air can resolve on its own;
An open pneumothorax is characterized by the presence of a hole in the chest wall. Through this opening, the pleural cavity communicates freely with the external environment. During inhalation, air enters the pleural cavity, and during exhalation, air exits through the defect. Open pneumothorax leads to collapse of the lung. A collapsed lung is switched off from breathing; gas exchange does not occur in such a lung, as a result the blood is not enriched with oxygen;
Tension or valvular pneumothorax is characterized by progressive accumulation of air in the pleural cavity. Tension pneumothorax occurs when a valve structure of the lung is formed, which allows air to pass in one direction, that is, during inhalation, air enters, but during exhalation, it cannot exit and remains in the pleural cavity. Valvular pneumothorax leads to a gradual increase in air in the pleural cavity. Tension pneumothorax is characterized by irritation of the nerve endings of the pleura, intrapleural pressure greater than atmospheric pressure, exclusion of the lung from breathing, displacement of mediastinal organs, pleuropulmonary shock, destruction of large vessels and respiratory failure.

All of the above types of pneumothorax can lead to serious complications, so this disease requires qualified treatment.

Symptoms of pneumothorax

Symptoms of pneumothorax depend on the mechanism of the disease, the causes and degree of collapse of the lung.

The disease manifests itself as a sharp onset of acute pain. Pain occurs with physical stress, coughing, or even for no apparent reason. The pain radiates to upper limb, neck, in the upper half of the abdomen. The pain intensifies when the chest moves. When symptoms of pneumothorax appear, the patient begins to breathe more frequently and shallowly. Breathing becomes difficult, and a dry cough appears. There is shortness of breath and a constant feeling of lack of air. The skin of the face becomes pale and bluish.

Diagnosis of the occurrence of the disease

Diagnosis of pneumothorax involves initial examination, which reveals characteristic symptoms pneumothorax.

In addition to examination, diagnosis of pneumothorax A involves x-ray examination, which allows you to determine the zone of clearing and the displacement of the mediastinal organs. A diagnostic pleural puncture is also performed.

Treatment of pneumothorax

Treatment of pneumothorax consists of first aid and qualified assistance.

First aid for pneumothorax

This disease is a medical emergency that requires immediate medical attention. Anyone should be ready to provide assistance in case of pneumothorax: the patient must be reassured, oxygen must be provided and a doctor must be immediately called.

If the patient has an open pneumothorax, first aid is to apply an occlusive dressing, which will help seal the defect in the chest. You can make your own airtight bandage from polyethylene and a thick cotton-gauze layer.

If the patient has a valvular pneumothorax, urgent Care consists of performing a pleural puncture, which allows you to remove free gas and expand the lung.

Qualified assistance for pneumothorax

A patient with this disease should be hospitalized in a surgical hospital in the pulmonology department. Emergency medical care for pneumothorax consists of performing a puncture of the pleural cavity,

In case of closed pneumothorax, air is aspirated. This procedure is performed using a long needle with an attached tube, that is, a minor operation is performed using asepsis.

In case of total pneumothorax, in order to avoid the patient's shock reaction, drainage is installed in the pleural cavity.

Treatment of open type pneumothorax consists of converting it to closed type, for this purpose the defect is sutured, which stops the flow of air into the pleural cavity.

Valvular pneumothorax, on the contrary, is converted into open pneumothorax using a puncture with a thick needle, after which surgical treatment is carried out.

Treatment of pneumothorax is accompanied by mandatory adequate pain relief.

Consequences of pneumothorax

In uncomplicated forms of spontaneous disease, the outcome is usually favorable, but relapses are possible. A complication of pneumothorax occurs in 50% of patients. The most common consequences of pneumothorax are:

hemopneumothorax;
exudative;
rigid lung;
pleural empyema;
acute respiratory failure;
mediastinal and subcutaneous emphysema

Such consequences of pneumothorax develop in almost half of patients with a spontaneous form of the disease.
There are no methods to prevent pneumothorax, but it is recommended to see a doctor regularly if you have lung disease. Patients who have had pneumothorax are recommended to be examined for tuberculosis and avoid physical activity.

Lung disease pneumothorax or pneumothorax is characterized by a symptom of accumulation of gas and air in the lungs, the causes of which are organ diseases or injuries. Depending on the factor that caused the disease, it is divided into primary, secondary and artificial. Symptoms of the pathology include chest pain and difficulty breathing. Complications include lack of oxygen, decreased blood pressure, and cardiac arrest.

What is pneumothorax

To get a full understanding of pneumothorax, it is necessary to find out the structure of the pleura, which consists of a visceral membrane covering the lung and a parietal membrane covering chest cavity. The slit-like space (pleural cavity) between them is filled with a special liquid that provides additional protection for the organs.

The entry and accumulation of air in the pleural cavity leads to a life-threatening pathology - pneumothorax, in which breathing is significantly limited and the blood vessels and heart are displaced. In the international classification of diseases, the disease is assigned code J 93. The subsections of this codification include several types of pathology.

Causes

Depending on the cause of air penetration into the pleural cavity, the disease is classified into primary and secondary. The causes of primary spontaneous pneumothorax are characterized by vagueness and lack of specifics. We can only talk about the risk group, which includes smoking young people under 30 years of age. Additional pathological factors include:

pressure changes (diving, aircraft ascent);
weakness of the pleura due to genetics, as a result of which rupture may occur, for example, due to severe coughing;
congenital alpha-1 antitryspin deficiency.

Secondary pneumothorax is characterized by specific pathologies in which the lungs bear significant destructive loads:

pathology connective tissue, Marfan syndrome, dermatomyositis, polymyositis, rheumatoid arthritis;
intestinal hernia;
lung pathologies in which the connective tissue of the lung is damaged (tuberous sclerosis, sarcoidosis)
infectious pulmonary pathologies: tuberculosis, pulmonary abscess, pneumonia.
oncological diseases: sarcoma, lung cancer;
respiratory tract pathologies (bronchial asthma, cystic fibrosis).

In newborns

Pneumothorax is most dangerous in newborns, so it is important to consider the causes that can lead to the disease. These include:

lung cyst, which can occur in a newborn as a result of defects intrauterine development;
genetic pathologies of the pulmonary region, leading to distortion of the shapes of emphysematous-dilated alveoli;
emergency ventilation of the infant;
rupture of a lung abscess as a result of hysterical crying.

Symptoms

The symptoms of pneumothorax are typical for many diseases, but distinctive feature of this disease is the severity of all characteristic signs. That is, symptoms can be severe or very severe, depending on the degree of lung collapse. The signs of the disease are as follows:

shortness of breath;
protrusion of intercostal tissue (especially when coughing);
bloating of the chest;
severe chest pain;
rapid breathing;
tachycardia;
lacrimation;
feeling of concern;
pallor of the skin.

Percussion sound with pneumothorax

Clarity in identifying the disease can be achieved by special tapping (percussion) of the patient and analysis of the resulting sounds. At open form pneumothorax, the pressure inside the pleural cavity is identical to atmospheric pressure, the sound is low. With a closed type, the pressure is often higher and volume is lost. The factor of tension in the chest can make tapping difficult, since in this case the sound loses its characteristic features. When tapped, the affected side produces a louder and clearer sound.

Kinds

Depending on various parameters, the classification of pneumothorax types can be complex. Depending on the type of development of the pathological process, the disease can be complicated (bleeding, etc.) or uncomplicated. If one lung is affected, a unilateral type is diagnosed, with two, by analogy with the previous one, a bilateral type.

Based on the volume and nature of the presence of air in the pleural area, the disease is classified as complete (total filling of the pleural cavity with air); parietal (limited air penetration); encysted (adhesions between the pleura stop the penetration zone). Significant differences in the nature of the connection between the pleural cavity and the environment:

Closed form. The trapped air volume is insignificant and does not increase.
Open type. There is communication with the external environment, the pressure inside the cavity is identical to atmospheric pressure.
Valve form (the most dangerous). Valves are formed through which air is pumped into the pleural cavity from the lung or the external environment.

Diagnostics

The doctor evaluates the patient's complaints for shortness of breath, sharp chest pain, shallow breathing and a feeling of lack of air. Additionally, the skin, sounds during exhalation and inhalation (auscultation) are examined. For staging accurate diagnosis are used laboratory research and assessment methods:

arterial blood gas analysis (hypoxemia in 75% of cases);
the size of pneumothorax is determined by palpation and an electrocardiogram (for the tense type);
for small lesions, computed tomography is used, which also helps to identify emphysematous bullae, cysts and the causes of the secondary spontaneous course of the disease.

X-ray

The most common method for diagnosing pneumothorax is radiography. It is optimal to carry it out in the anteroposterior version, placing the patient vertically. Diagnosis is made by visualizing a thin line of visceral pleura separated from the chest by less than a millimeter. Displacement of the mediastinum does not guarantee the disease, and 15% of cases may be accompanied by the appearance of pleural effusion.

Complications

Pneumothorax of the lungs occurs easily in 50% of cases, the remaining patients face consequences and complications:

exudative pleurisy;
hemopneumothorax (blood entering the pleural cavity);
pleural empyema (pyopneumothorax);
lung rigidity;
left-sided or right-sided lung collapse;
acute respiratory failure;
subcutaneous or mediastinal emphysema.

Treatment of pneumothorax

Small sudden hydropneumothorax resolves spontaneously without requiring specific treatment. If the disease is extensive or severe course, then the air is pumped out using a syringe or a one-way drainage is applied to the lung. If the drainage tube is ineffective or a recurrent spontaneous type occurs, resort to surgical treatment.

The main part of the treatment consists of suctioning air from the pleural cavity and restoring negative pressure:

Closed pneumothorax requires the use of puncture aspiration of gas from the cavity in an operating room. If the needle does not help, they resort to sealed drainage according to Bulau, or create an active aspiration system using electric vacuum devices.
Open pneumothorax requires thoracotomy and thoracoscopy, inspection of organs and elimination of damage to the thoracic pulmonary parenchyma. Consequences: the cavity is drained and sutured. If there are unruptured bullae, segment or lung lobe removed, chemical or physical pleurodesis is performed.
After treatment, the patient is prescribed painkillers, diuretics, oxygen therapy and supportive care of the heart and lungs.

First aid

The condition of pneumothorax is an emergency, so the person is urgently hospitalized. At the onset of the disease, it is necessary to calm the patient and provide him with a sufficient amount of oxygen. The open condition requires the application of an occlusive dressing, which will hermetically cover the chest wall defect. Valvular pneumothorax requires puncture of the pleural cavity to remove free gas with straightening of the lung tissue and eliminating organ displacement.

Operation

If tension pneumothorax is characterized by complications and drainage does not help, surgery is performed under general anesthesia. Its goals are sealing the defect, marginal tissue resection, and removal of the pleura. The result is fusion of the lungs and chest wall to prevent repeated relapses of the disease (efficacy is 97%). The surgery is performed using an endoscope: 3-4 small incisions are made in the chest. The operation lasts 45 minutes, the patient is discharged from the hospital after 4 days.

Forecast

If spontaneous pneumothorax is uncomplicated, the outcome in most cases is favorable. Otherwise, frequent relapses of the disease are possible if there are lung pathologies. The rate of recovery of respiratory function is influenced by the degree of lung damage and the development of the respiratory system. An unfavorable prognosis will be for wounds and injuries.

Prevention

To ensure that the air in the lungs functions normally and pneumothorax does not develop, there are special preventive methods:

undergo timely diagnosis and treatment of lung diseases;
in order to avoid relapse and complicated consequences, patients need to limit physical activity, be examined for chronic nonspecific lung diseases, tuberculosis;
preventing chest injuries;
quitting smoking and bad habits.

Video

Pneumothorax is a life-threatening condition that requires emergency medical care. Acute pathology often accompanies chest injuries, including gunshots and road accidents, and may also occur due to lung diseases or as a complication of some medical manipulations.

Pneumothorax of the chest is easy to suspect without instrumental examination. Knowing the symptoms of the condition will help promptly seek qualified help and save human life.

Pneumothorax - what is it?

A little anatomy. The lungs are covered with pleura, consisting of two layers. There is no air in the pleural cavity, so the pressure in it is negative. It is this fact that determines the functioning of the lungs: expansion during inhalation and collapse during exhalation.

Pneumothorax is a pathological entry of air into the pleural cavity due to its depressurization due to external trauma, pulmonary disease and other reasons.

At the same time, intrapleural pressure increases, preventing the expansion of the lungs during inspiration. A partially or completely collapsed lung is switched off from the breathing process, and blood circulation is disrupted.

Lack of timely assistance most often leads to the development of complications that threaten the patient’s life.

Causes and types of pneumothorax

Depending on the provoking factor, the following types of pneumothorax are divided:

Traumatic

Rupture of the pleural layers occurs with open injuries (knife blow, gunshot) and closed injuries(damage to the pleura by a broken rib, blunt blow to the chest while maintaining the integrity of the skin).

Spontaneous

The main cause of spontaneous pneumothorax is rupture of the pulmonary bubbles during bullous disease. The mechanism of occurrence of emphysematous expansions of lung tissue (bullas) has not yet been studied.

However, this disease is registered in most healthy people, especially after 40 years. Also, spontaneous rupture of the inner layer of the pleura and lung occurs with congenital weakness of the pleura, cavernous tuberculosis, abscess/gangrene of the lung.

Iatrogenic

Damage to the lung with the development of pneumothorax is often a complication of certain medical procedures: installation of a subclavian catheter, pleural puncture, intercostal nerve block, cardiopulmonary resuscitation (barotrauma).

Artificial

The deliberate creation of pneumothorax is resorted to in cases of widespread pulmonary tuberculosis and for diagnostic thoracoscopy.

Pneumothorax is also determined by the following indicators:

according to the degree of damage to the respiratory system - one-sided and two-sided;
depending on the degree of collapse of the lung: small or limited - less than 1/3 of the lung is excluded from breathing, medium - 1/3 - 1/2, total - more than half of the lung;
according to the nature of air entering the pleura: closed - the volume of air entered once does not increase, open - there is a direct connection between the pleural cavity and the environment, and the volume of incoming air constantly increases until the lung completely collapses, the most dangerous is tension (valvular) pneumothorax - a valve is formed , passing air in the direction environment- pleural cavity and its closing outlet;
depending on the complicating consequences - complicated and uncomplicated.

Spontaneous pneumothorax

If other types of pulmonary pneumothorax have a clearly defined external cause, spontaneous pneumothorax can occur even in healthy person with no history of injury or lung disease. Idiopathic (primary) pneumothorax occurs in the following situations:

sudden changes in pressure during air travel, diving;
genetic weakness of the pleura - rupture of the lung tissue and pleural layer can provoke laughter, physical stress (including straining with constipation), severe coughing;
congenital deficiency of alpha-1-antitrypsin - provokes the development pathological changes lung tissue.

Secondary spontaneous pneumothorax due to development pulmonary disease, occurs with pathologies:

damage to the respiratory tract - cystic fibrosis, emphysema, severe bronchial asthma;
connective tissue diseases affecting the lungs - lymphangioleiomyomatosis;
infections - abscess, gangrene, tuberculosis, as well as common pneumonia in HIV-infected people;
systemic diseases that occur with damage to the lungs - systemic scleroderma, rheumatoid arthritis, polymyositis;
oncopathology of the lungs.

The development of pneumothorax is always sudden, the severity of symptoms depends on the degree of collapse of the lung and the presence of complications.

6 main signs of pneumothorax:

Breathing problems - dry cough, shortness of breath, breathing becomes shallow.
The pain is sharp, intensifies with inhalation, and radiates to the shoulder on the side of the injury.
Subcutaneous emphysema - occurs when the outer layer of the pleura ruptures, air enters into the subcutaneous tissue, a swelling with crepitation (crunching of snow) is detected externally when pressing on it.
Foaming blood released from the wound is characteristic of an open pneumothorax.
External signs are a forced sitting posture, pallor and cyanosis of the skin (indicates developing circulatory and respiratory failure), cold sweat.
General symptoms are increasing weakness, panic, rapid heartbeat, drop in blood pressure, possible fainting.

First aid for pneumothorax

If symptoms of pneumothorax occur, the only correct tactic is:

Immediately call an ambulance and urgent hospitalization.
Conventional sterile dressing for open pneumothorax. An incorrectly applied occlusive dressing can lead to tension pneumothorax and rapid deterioration of the condition. Therefore, only a physician can apply it.
It is possible to administer Analgin (tablets, intramuscular injection).

Application of an occlusive dressing for pneumothorax:

Reassure the patient by explaining the algorithm of actions.
It is possible to use Promedol for pain relief.
Maintain sterility when opening packages with instruments and dressing material, use of sterile gloves.
The patient's position is with the arm slightly raised on the injured side. The bandage is applied while exhaling.
Layer-by-layer application of cotton-gauze pads to the wound, sealed packaging with the sterile side facing the wound and completely covering the pads placed on the wound, tight bandaging.

Diagnostics

Percussion (tapping) - a “box” sound on the side of the pneumothorax.
Auscultation (listening) - weakening of breathing on the affected side up to its absence.
X-ray - air in the pleura ( dark spot), collapsed lung, with the development of tension pneumothorax - a shift of the mediastinum to the healthy side.
CT scan not only detects even small volumes of air in the pleura, but also clearly determines the causative disease.

Additional diagnostic tests include laboratory analysis blood gas component and ECG (determines the degree of circulatory impairment in a tense form of pneumothorax).

Treatment of pneumothorax

After spontaneous pneumothorax with a limited volume of air supplied, no serious consequences, as a rule, does not arise. Even without treatment, small “air” cushions in the pleural cavity can resolve on their own without producing pronounced clinical symptoms. However, medical supervision of such a patient is mandatory.

In other cases it is required surgical intervention:

Closed pneumothorax- puncture of the pleural cavity and pumping out air. The ineffectiveness of this tactic indicates the entry of air into the pleura through the lungs. In this case, Bulau drainage or active aspiration with electric vacuum equipment is used.
Open pneumothorax- surgery with opening of the chest (thoracoscopy, thoracotomy) and revision of the lung tissue and pleura, suturing the injury, installing drainage.

If unruptured bullae are found during surgery, in order to avoid recurrent pneumothorax, a decision is made to resect a segment/lobe of the lung, a procedure for creating artificial pleurisy (pleurodesis).

Forecast

Uncomplicated forms of spontaneous pneumothorax usually end favorably. The outcome of an acute condition with significant collapse of the lung depends on the speed of medical care provided, since inflammation begins to develop after 4-6 hours. Relapses are also possible.

Immediate surgical intervention is required for valvular pneumothorax.

Consequences

Pleurisy and purulent empyema of the lungs with subsequent formation of adhesions and secondary respiratory failure.
Intrapleural bleeding.
Compression of the heart and coronary vessels air entering the mediastinum, the development of acute heart failure.
Mortal danger with a large volume of damage and deep injury to the lung tissue.

Pneumothorax - code according to ICD 10

In the international classification of diseases ICD 10 pneumothorax is:

Section X. J00-J99 - Respiratory diseases

J93 - Pneumothorax

J93.0 - Spontaneous tension pneumothorax
J93.1 - Other spontaneous pneumothorax
J93.8 - Other pneumothorax
J93.9 - Pneumothorax, unspecified

Additionally:

S27.0 - Traumatic pneumothorax
P25.1 - Pneumothorax occurring in the perinatal period