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2010 Annual Meeting Abstracts

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Pneumothorax on Positive Pressure Ventilation: Breath Easy
*Karim Fikry, *Sumbal Janjua, *Athanasios Bramos, *Hasan Alam, *David R King, George Velmahos, *Marc A deMoya
Massachusetts General Hospital, Boston, MA

1. Objective. There is ongoing debate about the need for routine drainage of pneumothorax (PTX) in patients requiring positive pressure ventilation (PPV). We hypothesized that the need for PPV does not mandate routine PTX drainage. Secondarily, we hypothesized that PTX size would predict the need for delayed drainage.
2. Design. Four year retrospective study
3. Setting. University, Level I trauma Hospital
4. Patients. 50 patients with 55 PTX admitted to the Trauma, Emergency Surgery service with a PTX and who required PPV. All included patients had an initial chest ctscan and were followed up for 7 days to detect the need for chest tube placement.
5. Main Outcome Measures. The need for chest tube drainage was the primary outcome measure. Secondary outcome measures included level of PEEP, maximal Peak Inspiratory Pressures (PIP), and the size of the PTX.
6. Results. In 55 pneumothoraces while on positive pressure ventilation 95% did not require chest tube drainage. There was no correlation between need for chest tube drainage and level of PEEP, PIP, or size.
7. Conclusions. Hemodynamically stable patients with a PTX while on PPV can be safely observed. Delayed drainage is required infrequently and does not cause adverse events.
Outcome measures
Needed drainageResolvedp-value
Size (mm)5.5 +/- 3.18.7 +/- 6.40.54
Volume (cc)2.7 +/- 2.812.7 +/- 24.71.00
Max PEEP5.0 +/- 0.06.1+/- 3.40.45
Max PIP27.3 +/- 7.527.0 +/- 5.90.98

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