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Published in: Critical Care 4/2005

Open Access 01-08-2005 | Research

Pneumothorax and mortality in the mechanically ventilated SARS patients: a prospective clinical study

Authors: Hsin-Kuo Kao, Jia-Horng Wang, Chun-Sung Sung, Ying-Che Huang, Te-Cheng Lien

Published in: Critical Care | Issue 4/2005

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Abstract

Introduction

Pneumothorax often complicates the management of mechanically ventilated severe acute respiratory syndrome (SARS) patients in the isolation intensive care unit (ICU). We sought to determine whether pneumothoraces are induced by high ventilatory pressure or volume and if they are associated with mortality in mechanically ventilated SARS patients.

Methods

We conducted a prospective, clinical study. Forty-one mechanically ventilated SARS patients were included in our study. All SARS patients were sedated and received mechanical ventilation in the isolation ICU.

Results

The mechanically ventilated SARS patients were divided into two groups either with or without pneumothorax. Their demographic data, clinical characteristics, ventilatory variables such as positive end-expiratory pressure, peak inspiratory pressure, mean airway pressure, tidal volume, tidal volume per kilogram, respiratory rate and minute ventilation and the accumulated mortality rate at 30 days after mechanical ventilation were analyzed. There were no statistically significant differences in the pressures and volumes between the two groups, and the mortality was also similar between the groups. However, patients developing pneumothorax during mechanical ventilation frequently expressed higher respiratory rates on admission, and a lower PaO2/FiO2 ratio and higher PaCO2 level during hospitalization compared with those without pneumothorax.

Conclusion

In our study, the SARS patients who suffered pneumothorax presented as more tachypnic on admission, and more pronounced hypoxemic and hypercapnic during hospitalization. These variables signaled a deterioration in respiratory function and could be indicators of developing pneumothorax during mechanical ventilation in the SARS patients. Meanwhile, meticulous respiratory therapy and monitoring were mandatory in these patients.
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Literature
1.
go back to reference Ksiazek TG, Erdman D, Goldsmith CS, Zaki SR, Peret T, Emery S, Tong S, Urbani C, Comer JA, Lim W, et al: A novel coronavirus associated with severe acute respiratory syndrome. N Engl J Med. 2003, 348: 1953-1966. 10.1056/NEJMoa030781.CrossRefPubMed Ksiazek TG, Erdman D, Goldsmith CS, Zaki SR, Peret T, Emery S, Tong S, Urbani C, Comer JA, Lim W, et al: A novel coronavirus associated with severe acute respiratory syndrome. N Engl J Med. 2003, 348: 1953-1966. 10.1056/NEJMoa030781.CrossRefPubMed
2.
go back to reference Rota PA, Oberste MS, Monroe SS, Nix WA, Campagnoli R, Icenogle JP, Penaranda S, Bankamp B, Maher K, Chen MH, et al: Characterization of a novel coronavirus associated with severe acute respiratory syndrome. Science. 2003, 300: 1394-1399. 10.1126/science.1085952.CrossRefPubMed Rota PA, Oberste MS, Monroe SS, Nix WA, Campagnoli R, Icenogle JP, Penaranda S, Bankamp B, Maher K, Chen MH, et al: Characterization of a novel coronavirus associated with severe acute respiratory syndrome. Science. 2003, 300: 1394-1399. 10.1126/science.1085952.CrossRefPubMed
3.
go back to reference Peiris JS, Chu CM, Cheng VC, Chan KS, Hung IFN, Poon LLM, Law KI, Tang BSF, Hon TYW, Chan CS, et al: Clinical progression and viral load in a community outbreak of coronavirus-associated SARS pneumonia: a prospective study. Lancet. 2003, 361: 1767-1772. 10.1016/S0140-6736(03)13412-5.CrossRefPubMed Peiris JS, Chu CM, Cheng VC, Chan KS, Hung IFN, Poon LLM, Law KI, Tang BSF, Hon TYW, Chan CS, et al: Clinical progression and viral load in a community outbreak of coronavirus-associated SARS pneumonia: a prospective study. Lancet. 2003, 361: 1767-1772. 10.1016/S0140-6736(03)13412-5.CrossRefPubMed
4.
go back to reference Lee N, Hui D, Wu A, Chan P, Cameron P, Joynt G, Ahuja A, Yung MY, Leung CB, To KF, et al: A major outbreak of severe acute respiratory syndrome in Hong Kong. N Engl J Med. 2003, 348: 1986-1994. 10.1056/NEJMoa030685.CrossRefPubMed Lee N, Hui D, Wu A, Chan P, Cameron P, Joynt G, Ahuja A, Yung MY, Leung CB, To KF, et al: A major outbreak of severe acute respiratory syndrome in Hong Kong. N Engl J Med. 2003, 348: 1986-1994. 10.1056/NEJMoa030685.CrossRefPubMed
5.
go back to reference Booth CM, Matukas LM, Tomlinson GA, Rachlis AR, Rose DB, Dwosh HA, Walmsley SL, Mazzulli T, Avendano M, Derkach P, et al: Clinical features and short-term outcomes of 144 patients with SARS in the greater Toronto area. JAMA. 2003, 289: 2801-2809. 10.1001/jama.289.21.JOC30885.CrossRefPubMed Booth CM, Matukas LM, Tomlinson GA, Rachlis AR, Rose DB, Dwosh HA, Walmsley SL, Mazzulli T, Avendano M, Derkach P, et al: Clinical features and short-term outcomes of 144 patients with SARS in the greater Toronto area. JAMA. 2003, 289: 2801-2809. 10.1001/jama.289.21.JOC30885.CrossRefPubMed
6.
go back to reference Lew TWK, Kwek TK, Tai D, Earnest A, Loo S, Singh K, Kwan KM, Chan Y, Yim CF, Bek SL, et al: Acute respiratory distress syndrome in critically ill patients with severe acute respiratory syndrome. JAMA. 2003, 290: 374-380. 10.1001/jama.290.3.374.CrossRefPubMed Lew TWK, Kwek TK, Tai D, Earnest A, Loo S, Singh K, Kwan KM, Chan Y, Yim CF, Bek SL, et al: Acute respiratory distress syndrome in critically ill patients with severe acute respiratory syndrome. JAMA. 2003, 290: 374-380. 10.1001/jama.290.3.374.CrossRefPubMed
7.
go back to reference Fowler RA, Lapinsky SE, Hallett D, Detsky AS, Sibbald WJ, Slutsky AS, Stewart TE, the Toronto SARS Critical Care Group: Critically ill patients with severe acute respiratory syndrome. JAMA. 2003, 290: 367-373. 10.1001/jama.290.3.367.CrossRefPubMed Fowler RA, Lapinsky SE, Hallett D, Detsky AS, Sibbald WJ, Slutsky AS, Stewart TE, the Toronto SARS Critical Care Group: Critically ill patients with severe acute respiratory syndrome. JAMA. 2003, 290: 367-373. 10.1001/jama.290.3.367.CrossRefPubMed
8.
go back to reference Bernard GR, Artigas A, Brigham KL, Carlet J, Falke K, Hudson L, Lamy M, Legall J, Morris A, Spragg R: The American-European consensus conference on ARDS: definitions, mechanisms, relevant outcomes and clinical trial coordination. Am J Respir Crit Care Med. 1994, 149: 818-824.CrossRefPubMed Bernard GR, Artigas A, Brigham KL, Carlet J, Falke K, Hudson L, Lamy M, Legall J, Morris A, Spragg R: The American-European consensus conference on ARDS: definitions, mechanisms, relevant outcomes and clinical trial coordination. Am J Respir Crit Care Med. 1994, 149: 818-824.CrossRefPubMed
9.
go back to reference Petersen GW, Baier H: Incidence of pulmonary barotraumas in a medical ICU. Crit Care Med. 1983, 11: 67-69.CrossRefPubMed Petersen GW, Baier H: Incidence of pulmonary barotraumas in a medical ICU. Crit Care Med. 1983, 11: 67-69.CrossRefPubMed
10.
go back to reference Schnapp LM, Chin DP, Szaflarski N, Matthay MA: Frequency and importance of barotraumas in 100 patients with acute lung injury. Crit Care Med. 1995, 23: 272-278. 10.1097/00003246-199502000-00012.CrossRefPubMed Schnapp LM, Chin DP, Szaflarski N, Matthay MA: Frequency and importance of barotraumas in 100 patients with acute lung injury. Crit Care Med. 1995, 23: 272-278. 10.1097/00003246-199502000-00012.CrossRefPubMed
11.
go back to reference Gattinoni L, Bombino M, Pelosi P, Lissoni A, Pesenti A, Fumagalli R, Tagliabue M: Lung structure and function in different stages of severe adult respiratory distress syndrome. JAMA. 1994, 271: 1772-1779. 10.1001/jama.271.22.1772.CrossRefPubMed Gattinoni L, Bombino M, Pelosi P, Lissoni A, Pesenti A, Fumagalli R, Tagliabue M: Lung structure and function in different stages of severe adult respiratory distress syndrome. JAMA. 1994, 271: 1772-1779. 10.1001/jama.271.22.1772.CrossRefPubMed
12.
go back to reference Eisner MD, Thompson BT, Schoenfeld D, Anzueto A, Matthay MA, the Acute Respiratory Distress Syndrome Network: Airway pressures and early barotraumas in patients with acute lung injury and acute respiratory distress syndrome. Am J Respir Crit Care Med. 2002, 165: 978-982.CrossRefPubMed Eisner MD, Thompson BT, Schoenfeld D, Anzueto A, Matthay MA, the Acute Respiratory Distress Syndrome Network: Airway pressures and early barotraumas in patients with acute lung injury and acute respiratory distress syndrome. Am J Respir Crit Care Med. 2002, 165: 978-982.CrossRefPubMed
13.
go back to reference Gammon RB, Shin MS, Groves RH, Hardin JM, Hsu C, Buchalter SE: Clinical risk factors for pulmonary barotraumas: a multivariate analysis. Am J Respir Crit Care Med. 1995, 152: 1235-1240.CrossRefPubMed Gammon RB, Shin MS, Groves RH, Hardin JM, Hsu C, Buchalter SE: Clinical risk factors for pulmonary barotraumas: a multivariate analysis. Am J Respir Crit Care Med. 1995, 152: 1235-1240.CrossRefPubMed
14.
go back to reference Weg JG, Anzueto A, Balk RA, Wiedemann HP, Pattishall EN, Schork MA, Wagner LA: The relation of pneumothorax and other air leaks to mortality in the acute respiratory distress syndrome. N Engl J Med. 1998, 338: 341-346. 10.1056/NEJM199802053380601.CrossRefPubMed Weg JG, Anzueto A, Balk RA, Wiedemann HP, Pattishall EN, Schork MA, Wagner LA: The relation of pneumothorax and other air leaks to mortality in the acute respiratory distress syndrome. N Engl J Med. 1998, 338: 341-346. 10.1056/NEJM199802053380601.CrossRefPubMed
15.
go back to reference Boussarsar M, Thierry G, Jaber S, Roudot-Thoraval F, Lemaire F, Brochard L: Relationship between ventilatory settings and barotraumas in the acute respiratory distress syndrome. Intensive Care Med. 2002, 28: 406-413. 10.1007/s00134-001-1178-1.CrossRefPubMed Boussarsar M, Thierry G, Jaber S, Roudot-Thoraval F, Lemaire F, Brochard L: Relationship between ventilatory settings and barotraumas in the acute respiratory distress syndrome. Intensive Care Med. 2002, 28: 406-413. 10.1007/s00134-001-1178-1.CrossRefPubMed
17.
go back to reference Murray JF, Matthay MA, Luce JM, Flick MR: An expanded definition of the adult respiratory distress syndrome. Am Rev Respir Dis. 1988, 138: 720-723.CrossRefPubMed Murray JF, Matthay MA, Luce JM, Flick MR: An expanded definition of the adult respiratory distress syndrome. Am Rev Respir Dis. 1988, 138: 720-723.CrossRefPubMed
18.
go back to reference Choi KW, Chau TN, Tsang O, Tso E, Chiu MC, Tong WL, Lee PO, Ng TK, Ng WF, Lee KC, the Princess Margaret Hospital SARS Study Group, et al: Outcomes and prognostic factors in 267 patients with severe acute respiratory syndrome in Hong Kong. Ann Intern Med. 2003, 139: 715-723.CrossRefPubMed Choi KW, Chau TN, Tsang O, Tso E, Chiu MC, Tong WL, Lee PO, Ng TK, Ng WF, Lee KC, the Princess Margaret Hospital SARS Study Group, et al: Outcomes and prognostic factors in 267 patients with severe acute respiratory syndrome in Hong Kong. Ann Intern Med. 2003, 139: 715-723.CrossRefPubMed
19.
go back to reference Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. The Acute Respiratory Distress Syndrome Network. N Engl J Med. 2000, 342: 1301-1308. 10.1056/NEJM200005043421801. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. The Acute Respiratory Distress Syndrome Network. N Engl J Med. 2000, 342: 1301-1308. 10.1056/NEJM200005043421801.
20.
go back to reference Gammon RB, Shin MS, Buchalter SE: Pulmonary barotraumas in mechanical ventilation. Patterns and risk factors. Chest. 1992, 102: 568-572.CrossRefPubMed Gammon RB, Shin MS, Buchalter SE: Pulmonary barotraumas in mechanical ventilation. Patterns and risk factors. Chest. 1992, 102: 568-572.CrossRefPubMed
21.
go back to reference Knaus WA, Draper EA, Wagner DP, Zimmerman JE: APACHE II: a severity of disease classification system. Crit Care Med. 1985, 13: 818-829.CrossRefPubMed Knaus WA, Draper EA, Wagner DP, Zimmerman JE: APACHE II: a severity of disease classification system. Crit Care Med. 1985, 13: 818-829.CrossRefPubMed
22.
go back to reference Joynt GM, Antonio GE, Lam P, Wong KT, Li T, Gomersall CD, Ahuja AT: Late stage adult respiratory distress syndrome caused by severe acute respiratory syndrome: abnormal findings at thin-section CT. Radiology. 2004, 230: 339-346.CrossRefPubMed Joynt GM, Antonio GE, Lam P, Wong KT, Li T, Gomersall CD, Ahuja AT: Late stage adult respiratory distress syndrome caused by severe acute respiratory syndrome: abnormal findings at thin-section CT. Radiology. 2004, 230: 339-346.CrossRefPubMed
23.
go back to reference DiRusso SM, Nelson LD, Safcsak K, Miller RS: Survival in patients with severe adult respiratory distress syndrome treated with high-level positive end-expiratory pressure. Crit Care Med. 1995, 23: 1485-1496. 10.1097/00003246-199509000-00008.CrossRefPubMed DiRusso SM, Nelson LD, Safcsak K, Miller RS: Survival in patients with severe adult respiratory distress syndrome treated with high-level positive end-expiratory pressure. Crit Care Med. 1995, 23: 1485-1496. 10.1097/00003246-199509000-00008.CrossRefPubMed
24.
go back to reference Tsang KW, Ho PL, Ooi GC, Yee WK, Wang T, Chan-Yeung M, Lam WK, Seto WH, Yam LY, Cheung TM, et al: A cluster of cases of severe acute respiratory syndrome in Hong Kong. N Engl J Med. 2003, 348: 1977-1985. 10.1056/NEJMoa030666.CrossRefPubMed Tsang KW, Ho PL, Ooi GC, Yee WK, Wang T, Chan-Yeung M, Lam WK, Seto WH, Yam LY, Cheung TM, et al: A cluster of cases of severe acute respiratory syndrome in Hong Kong. N Engl J Med. 2003, 348: 1977-1985. 10.1056/NEJMoa030666.CrossRefPubMed
25.
go back to reference Peiris JSM, Lai ST, Poon LLM, Guan Y, Yam LYC, Lim W, Nicholls J, Yee WKS, Yan WW, Cheung MT, et al: Coronavirus as a cause of severe acute respiratory syndrome. Lancet. 2003, 361: 1319-1325. 10.1016/S0140-6736(03)13077-2.CrossRefPubMed Peiris JSM, Lai ST, Poon LLM, Guan Y, Yam LYC, Lim W, Nicholls J, Yee WKS, Yan WW, Cheung MT, et al: Coronavirus as a cause of severe acute respiratory syndrome. Lancet. 2003, 361: 1319-1325. 10.1016/S0140-6736(03)13077-2.CrossRefPubMed
26.
27.
go back to reference Chan JW, Ng CK, Chan YH, Mok TY, Lee S, Chu SYY, Law WL, Lee MP, Li PCK: Short term outcome and risk factors for adverse clinical outcomes in adult with severe acute respiratory syndrome (SARS). Thorax. 2003, 58: 686-689. 10.1136/thorax.58.8.686.PubMedCentralCrossRefPubMed Chan JW, Ng CK, Chan YH, Mok TY, Lee S, Chu SYY, Law WL, Lee MP, Li PCK: Short term outcome and risk factors for adverse clinical outcomes in adult with severe acute respiratory syndrome (SARS). Thorax. 2003, 58: 686-689. 10.1136/thorax.58.8.686.PubMedCentralCrossRefPubMed
Metadata
Title
Pneumothorax and mortality in the mechanically ventilated SARS patients: a prospective clinical study
Authors
Hsin-Kuo Kao
Jia-Horng Wang
Chun-Sung Sung
Ying-Che Huang
Te-Cheng Lien
Publication date
01-08-2005
Publisher
BioMed Central
Published in
Critical Care / Issue 4/2005
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/cc3736

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