Treatment of Occult Pneumothorax

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Scott answers, do we need to drain an occult pneumothorax? From EMA April 2022.

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Kenneth A. -

Would you consider lowering Tidal volumes while watching w/o a chest tube, and watching carefully changing pressures?

@skobner -

Hey Kenneth, great question!

In the paper discussed, there was no specific changes to ventilator strategies described for patients with known pneumothoraces. This also wasn't specifically studied or controlled for, so take that as you will.

Personally, I have approached these cases similar to an ARDS net ventilator strategy, with peak and plateau pressures being my greatest concern. The idea here being there must be some small clot which has formed to plug the hole that caused the pneumothorax, and a spike in pressure could dislodge it. Just as you said, I closely monitor these pressures over time as my canary in the coal mine for a growing pneumo.

At the end of the day, if the person needs a certain ventilation strategy (whether it be a pressure, volume, etc) to stabilize them, that will always take priority. We can always place the chest tube if needed.

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