Air in the lung after surgery. Emergency care for closed and open pneumothorax

Pneumothorax is a disease in which air gradually accumulates in the pleural cavity. This condition requires immediate hospitalization. This article provides information on the topic "Pneumothorax: what is it?", The causes and symptoms of the pathology are considered.

Description of the disease

The human lungs are fully functional when the pressure in them is higher than in the pleural cavity. If air enters the latter due to some reason, this figure increases markedly. The lungs react to this disorder by changing their size, which causes other symptoms due to oxygen deficiency.

In medicine, this condition is called pneumothorax. It usually occurs in young people under the age of 40. If symptoms of a deterioration in the general condition of the patient appear, it is necessary to be hospitalized urgently. Otherwise, the likelihood of life-threatening complications increases.

Causes and types of disease

How does pneumothorax develop, what is it? The disease occurs against the background of many reasons that determine its specific type. Based on this, physicians distinguish the following classification of pathology:

1. Spontaneous pneumothorax. It develops for no apparent reason (primary) or against the background of ailments (secondary). It is usually diagnosed in underweight men aged 20 to about 40 years. The disease is based on a hereditary predisposition or lung defect. In addition, pneumonia or tuberculosis can be the cause of this type of pathology.
2. Traumatic pneumothorax. It develops as a result of trauma to the thoracic region, both from a penetrating wound and from internal damage. In the first case, the air passes directly into the pleural cavity through an open wound, and then it is removed with the help of it. In the second case, it is diagnosed. Due to this pathology, air freely enters the pleural region.
3. Iatrogenic pneumothorax. It develops as a result of therapeutic or diagnostic manipulations (lung biopsy, puncture, catheterization).

The presented classification allows correctly diagnosing pneumothorax and prescribing adequate treatment.

Clinical picture of the disease

Pathology begins its development with the appearance of acute pain in the chest, which can radiate to the neck or upper abdomen. Discomfort is felt when breathing or exercising. As the disease progresses, stiffness in the chest appears, the person feels a lack of air. This is due to increasing pressure in the pleural cavity and compression of the lung. There is also shortness of breath, which does not bring the desired relief.

An acute lack of oxygen leads to pallor of the skin. In addition, there is a rapid heartbeat and excessive sweating.

Forms of pneumothorax

The presence / absence of communication with the environment allows us to classify the disease according to the following forms:

• Closed. It develops when air enters the pleural region. Clinically, this form of pathology is characterized by the mildest course. Small volumes of air can be absorbed on their own.
• Open. There is an accumulation of excess air in the pleural cavity, which communicates with the environment through a damaged bronchus or chest wall wound. With each inhalation, air passes into the pleural cavity, and with each exhalation it exits back. The pressure becomes equal to atmospheric, which entails the collapse of the lung.
• valve. This form of pneumothorax is considered the most severe. If the wound is large, a complex valvular structure is formed. When you inhale, air enters the pleural cavity, but when you exhale, it cannot come out. Its volume is gradually increasing. The disease leads to displacement and compression of the mediastinal organs, respiratory and circulatory disorders.

Depending on the volume of air in the pleural region, limited, medium and total pneumothorax is isolated. In the latter case, the lung accounts for less than half of the normal volume.

Features of the disease in children

Pneumothorax in newborns can occur immediately after the first few breaths. In this case, we are talking about a spontaneous form of the disease. It develops with uneven expansion of the lungs, which usually occurs due to malformations of the baby. In children under three years of age, this condition may be a complication of pneumonia. In adolescence, such a disorder occurs during a cough during the next attack of bronchial asthma.

Pneumothorax in children may not manifest clinically. Sometimes there is a short-term cessation of breathing, in more serious cases - cyanosis of the skin, convulsions, heart palpitations. The principles of treatment are the same as for adults.

Diagnostics

Competent and timely diagnosis is extremely important if pneumothorax is suspected, since this condition often leads to complications. To confirm the disease, the appearance of the patient plays a special role, which usually combines all the symptoms of the pathology described above. In addition, a person is forced to take a certain position (sitting or reclining position), then the pressure in the pleural cavity is not felt so much.

A physical examination is not enough to make a diagnosis, so patients are given a chest x-ray if pneumothorax is suspected. What it is? This study is highly informative and allows you to identify the affected areas, the edges of the collapsed lung.

Radiography is not the only diagnostic method. If pneumothorax is suspected, computed tomography, a blood test for the presence of gases, and electrocardiography are also prescribed.

First aid

Pneumothorax is considered a medical emergency. Each person should be able to provide emergency assistance to the victim: calm him down, provide oxygen access, call a team of medical workers.

If there is an open pneumothorax, the bandage is applied in such a way as to hermetically close the defect in the sternum wall. In an emergency, in the absence of sterile materials, improvised means (shirts, T-shirts) can be used. The cleanest piece of tissue must be applied directly to the wound itself. To seal the affected area, cellophane or polyethylene is applied over the bandage.

When the patient is required to remove free gas, eliminate the displacement of the mediastinal organs and straighten the lung.

It is important to simplify the breathing process for the patient as much as possible. To do this, it must be laid on an elevated surface. In case of fainting, the person should be brought to his senses. When ammonia is not at hand, it can be replaced with any product with a pungent odor (perfume, gasoline). After providing first aid, you should wait for the medical team.

Treatment in a hospital

Patients with pneumothorax are required to be hospitalized. In a hospital, specialists make a puncture of the pleural cavity, due to which excess air comes out. Treatment directly depends on the specific form of the disease.

Conservative therapy is relevant if we are talking about a closed small pneumothorax. The patient must be provided with bed rest, if necessary, painkillers are prescribed.

With a total variant of the disease, drainage is installed in the pleural cavity. This is necessary to prevent a shock reaction and restore the lung.

If the patient has an open pneumothorax, the assistance provided before the arrival of the medical team can save the patient's life. The main task of doctors is to translate the pathology into a closed form. To do this, the wound is sutured, as a result of which the penetration of air into the pleural cavity stops. This is followed by manipulations similar to those required for the diagnosis of "closed pneumothorax".

After the operation, the patient is recommended to completely abandon physical activity for four weeks. Air travel is prohibited for 14 days from the date of treatment. Doctors advise against diving and other active sports. All this causes pressure drops.

Prognosis after treatment

The outcome of the disease largely depends on the age and sex of the patient, the presence of complications and concomitant ailments. Spontaneous pulmonary pneumothorax, which occurs against the background of a hereditary predisposition, is characterized by a favorable outcome.

In 20% of cases, patients experience a relapse of the pathology, especially if it is caused by a primary disease. Such a condition of a person is considered dangerous when the pleural cavity is filled with air from both sides. This usually results in acute and fatal outcome. The bilateral form of pneumothorax is characterized by a favorable outcome in only 50% of cases. This indicator is strongly influenced by the timeliness and quality of first aid.

Complications of pneumothorax

Approximately half of those affected by this disease develop various complications. Among them, bleeding into the pleural cavity is considered the most common, which in most cases has a favorable outcome. With extensive blood loss, doctors record the death of the patient. Even if it is possible to normalize the patient's condition, the risk of heart and respiratory failure increases. Both of these conditions are life-threatening.

With a traumatic version of pneumothorax, there is a risk of infection of the wound and the formation of air gradually penetrates into the subcutaneous fat, which is already a dangerous condition. Another complication of this pathology is inflammation of the pleura. It is accompanied by a vivid clinical picture and requires thorough treatment.

Preventive actions

There are no specific methods for preventing the disease. To prevent this pathology, doctors recommend adhering to a healthy lifestyle, giving up bad habits, treating ailments in a timely manner and spending more time outdoors.

From the materials in this article, you learned why pneumothorax develops, what it is, what are its main symptoms. When the primary signs of pathology appear, you should not panic. Pneumothorax is not a sentence; most patients successfully cope with such a diagnosis. Timely and high-quality treatment allows you to stop the pathology, prevent the development of complications.

• Sudden onset chest pain - sharp, aggravated during inhalation; may radiate to the shoulder of the affected side.
• Sudden shortness of breath - shortness of breath, rapid shallow breathing.
• Possible dry cough.
• Increased heart rate.
• A cold sticky sweat appears on the skin.
• General weakness.
• Feeling of fear.
• With severe respiratory and circulatory disorders - cyanosis of the skin.
• With an open pneumothorax (the presence of a chest wound through which the pleural cavity communicates with the external environment), during inhalation, air is sucked through the wound with a whistle; during exhalation, air exits through the wound, “foaming” the blood released from the wound.

Forms

• Closed pneumothorax- develops in cases where air enters the pleural cavity through a pleural defect, but the defect is small and closes quickly. There is no communication between the pleural cavity and the environment, and the volume of air entering the pleural cavity does not increase. Clinically, it has the easiest course: a small amount of air can resolve itself.
• Open pneumothorax- such an accumulation of air in the pleural cavity, which communicates with the environment through a wound in the chest wall or through a damaged large bronchus. When you inhale, air enters the pleural cavity, and when you exhale, it comes out. The pressure in the pleural cavity becomes equal to atmospheric pressure, which leads to the collapse of the lung and turning it off from breathing.
• Valvular (tension) pneumothorax- the most difficult option. If the wound is large and a medium-sized bronchus is damaged, a valve structure is formed that allows air to enter the pleural cavity at the moment of inhalation and prevents it from escaping into the environment during exhalation, while the volume of air in the pleural cavity gradually increases. This leads to displacement and compression of the mediastinal organs (heart, large vessels) with significant respiratory and circulatory disorders.

Causes

According to the causes of occurrence, the following types of pneumothorax are distinguished.

• Spontaneous (spontaneous) pneumothorax- rupture of the bronchus or a section of the lung, not associated with mechanical damage to the lungs or chest.
  • Primary(idiopathic) - occurs for no apparent reason. It is more common in young tall men aged 20-40 years. As a rule, it is based on:
    • genetically determined deficiency of the enzyme alpha-1-antitrypsin, which leads to pathological changes in the lungs;
    • congenital weakness of the pleura, which is easily torn with a strong cough, laughter, deep breathing, intense physical effort;
    • it is possible to develop spontaneous pneumothorax with deep immersion in water, diving, flying in an airplane at high altitude (associated with pressure drops).
  • Secondary(symptomatic) - against the background of the existing pulmonary pathology:
    • respiratory diseases, for example, chronic obstructive pulmonary disease (COPD is a chronic inflammatory disease of the respiratory system that occurs under the influence of various environmental factors, the main of which is smoking, leading to the development of chronic respiratory failure), cystic fibrosis (a hereditary disease characterized by impaired function of the glands of the external secretion, including bronchial, which leads to the appearance of viscous thick sputum), severe exacerbation of bronchial asthma;
    • infectious diseases of the lungs: for example, tuberculosis (an infectious disease caused by Mycobacterium tuberculosis), lung abscess (a limited focus of inflammation of the lung tissue with its melting and the formation of a cavity filled with purulent masses), pneumonia (pneumonia) against the background of HIV infection;
    • lung diseases in which the connective tissue is affected: fibrosing alveolitis, lymphangioleiomyomatosis, sarcoidosis, histiocytosis X;
    • systemic connective tissue diseases with lung damage (systemic scleroderma, rheumatoid arthritis, dermatomyositis);
    • tumors (lung cancer).
• Traumatic pneumothorax - for chest trauma:
  • penetrating wound of the chest;
  • blunt chest trauma.
• iatrogenic pneumothorax, associated with medical procedures:
  • with a biopsy (taking a small area for research) of the lungs or pleura;
  • at a puncture (a puncture of a pleural cavity for the purpose of pumping out of pathological contents);
  • when placing a subclavian catheter;
  • during artificial ventilation of the lungs (barotrauma).

Diagnostics

• General examination (examination of the chest, listening to the lungs with a phonendoscope).
• X-ray of the chest, which allows you to detect air in the pleural cavity (the cavity formed by the sheets of the pleura - the outer lining of the lungs). It is the main method for diagnosing pneumothorax.
• Computed tomography - to identify the causes of secondary spontaneous pneumothorax and with insufficient information content of radiography.
• The study of the gas composition of the blood. The method is auxiliary.
• Electrocardiography (ECG) - allows you to detect changes in the work of the heart with tension (valvular) pneumothorax. The method is auxiliary.
• It is also possible to consult a thoracic surgeon,.

Treatment of pneumothorax

• If there is a small amount of air in the pleural cavity that does not disturb the breathing mechanism, it can resolve itself and does not require treatment.
• Pleural puncture with suction of air from the pleural cavity (the cavity formed by the pleura sheets - the outer shell of the lungs).
• Drainage of the pleural cavity with the establishment of a drainage tube through which air will be removed from the pleural cavity.
• Surgical suturing of ruptures of the lung, bronchi, wounds of the chest wall.
• Painkillers (for severe pain).
• Oxygen therapy (long-term oxygen supply through special tube systems).
• Pleurodesis - fusion of the pleura with the help of special preparations introduced into the pleural cavity or surgically (with frequently recurring pneumothoraxes).

Complications and consequences

• Intrapleural bleeding.
• Pleurisy - inflammation of the pleura with the possible formation of adhesions, leading to a violation of the expansion of the lung.
• Subcutaneous emphysema - the release of air into the subcutaneous fat. It is defined as areas of bloating, swelling of the subcutaneous tissue, when pressed, a sound occurs that resembles the crunch of dry snow.
• Penetration of air into the tissue of the mediastinum with compression of the heart and large vessels.
• In severe cases (a large amount of damage, a significant penetrating wound of the chest), a fatal outcome is possible.

Prevention of pneumothorax

• Timely treatment of lung diseases.
• To give up smoking.
• Prevention of chest injury.
• Prevention of repeated pneumothoraxes (with their frequent repetition) - pleurodesis (fusion of the pleura sheets with the help of special preparations introduced into the pleural cavity or surgically).

Pneumothorax is a life-threatening medical emergency. Acute pathology often accompanies chest injuries, including gunshots and road accidents, and can also occur due to lung disease or as a complication of certain medical procedures.

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 bit of anatomy. The lungs are covered with a pleura consisting of two sheets. There is no air in the pleural cavity, so the pressure in it is negative. It is this fact that determines the work of the lungs: straightening during inhalation and subsidence 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, blood circulation is disturbed.

The lack of timely assistance most often leads to the development of complications that threaten the life of the patient.

Causes and types of pneumothorax

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

• Traumatic

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

• Spontaneous

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

However, this disease is recorded in most healthy people, especially after 40 years. Also, spontaneous rupture of the inner pleura and lung occurs with congenitally developed 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 some medical procedures: installation of a subclavian catheter, pleural puncture, blockade of the intercostal nerve, cardiopulmonary resuscitation (barotrauma).

• Artificial

The intentional creation of pneumothorax is resorted to with 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 - unilateral and bilateral;
• depending on the degree of lung collapse: small or limited - less than 1/3 of the lung is turned off 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 that once entered does not increase, open - there is a direct communication between the pleural cavity and the environment, and the volume of incoming air constantly increases until the lung completely collapses, the most dangerous tension (valvular) pneumothorax - a valve is formed , passing air in the direction of the environment - the pleural cavity and closing its outlet;
• depending on the complicating consequences - complicated and uncomplicated.

Spontaneous pneumothorax

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

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

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

• damage to the respiratory tract - cystic fibrosis, emphysema, severe bronchial asthma;
• connective tissue diseases that affected the lungs - lymphangioleiomyomatosis;
• infections - abscess, gangrene, tuberculosis, as well as common pneumonia in HIV-infected people;
• systemic diseases occurring with lung damage - 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:

1. Breathing problems - dry cough, shortness of breath, breathing becomes shallow.
2. The pain is sharp, aggravated by inhalation, radiating to the shoulder from the side of the injury.
3. Subcutaneous emphysema - occurs when the outer layer of the pleura ruptures, air on exhalation enters the subcutaneous tissue, swelling with crepitus (crunching of snow) is externally detected when pressed on it.
4. Foaming blood released from the wound is characteristic of an open pneumothorax.
5. External signs - a forced sitting posture, pallor and cyanosis of the skin (indicates developing circulatory and respiratory failure), cold sweat.
6. Common symptoms are increasing weakness, panic, palpitations, a drop in a / d, fainting is possible.

First aid for pneumothorax

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

1. Immediate call for an ambulance and urgent hospitalization.
2. Plain sterile dressing for open pneumothorax. An improperly applied occlusive dressing can lead to a tension pneumothorax and a rapid deterioration in the condition. Therefore, its imposition is carried out only by a physician.
3. Perhaps the introduction of Analgin (tablets, intramuscular injection).

Applying an occlusive dressing for pneumothorax:

• Reassure the patient by explaining the algorithm of actions.
• It is possible to use Promedol for pain relief.
• Compliance with sterility when opening packages with tools and dressings, use of sterile gloves.
• The position of the patient is a slightly raised hand on the injured side. The dressing is applied on exhalation.
• Layer-by-layer imposition of cotton-gauze discs on the wound, sealed packaging with a sterile side to the wound and completely covering the pads applied to the wound, tight bandaging.

Diagnostics

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

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

Treatment of pneumothorax

After a spontaneous pneumothorax with a limited volume of incoming air, as a rule, no serious consequences occur. Even without treatment, small "air" pillows in the pleural cavity can resolve on their own, without giving severe clinical symptoms. However, medical supervision of such a patient is mandatory.

In other cases, surgery is required:

1. 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 electrovacuum equipment is used.
2. Open pneumothorax- surgery with opening the chest (thoracoscopy, thoracotomy) and revision of the lung tissue and pleura, suturing damage, installing drainage.

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

Forecast

Uncomplicated forms of spontaneous pneumothorax usually end favorably. The outcome of an acute condition with a significant collapse of the lung depends on the speed of the medical care provided, since inflammation begins to develop after 4-6 hours. Relapses are also not ruled out.

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 by air entering the mediastinum, the development of acute heart failure.
• Mortal danger with a large amount of damage and deep injury to the lung tissue.

Pneumothorax - ICD code 10

In the international classifier of diseases ICD 10 pneumothorax is:

Section X J00-J99 - Diseases of the respiratory system

J93 - Pneumothorax

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

Additionally:

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

- partial or complete collapse of the lung, due to the ingress of air into the pleural cavity; while the pleural cavity does not communicate with the external environment, and the amount of gas during breathing does not increase. Manifested by pain in the chest on the side of the lesion, a feeling of lack of air, pallor and cyanosis of the skin, the patient's desire to take a forced position, the presence of subcutaneous emphysema. The diagnosis of closed pneumothorax is confirmed by auscultation and x-ray. Medical care includes pain relief, oxygen therapy, pleural puncture or drainage.

General information

The following predispose to the development of pathology: prematurity (underdevelopment of the pleura, mediastinal tissue, connective tissue, broncho-alveolar tracts), addiction to smoking, connective tissue dysplasia, aggravated heredity.

With a closed pneumothorax, air enters the pleural cavity at the time of injury or damage to the lung. In the absence of a valve mechanism, the defect in the lung tissue quickly closes, the amount of air in the pleural cavity does not increase, the pressure in it does not exceed atmospheric pressure, and there is no mediastinal flotation.

Tension pneumothorax, which is a complication of valvular pneumothorax, can be considered as closed by its mechanism. First, there is a progressive injection of air into the pleural cavity through the wound channel in the chest wall (external valvular pneumothorax) or damaged large bronchi (internal valvular pneumothorax). As the amount of air and pressure in the pleural cavity increase, the wound defect subsides, which marks the development of a tension pneumothorax. In this case, there is a dislocation of the structures of the mediastinum, compression of the SVC, life-threatening respiratory and circulatory disorders.

Symptoms of closed pneumothorax

The clinic of closed pneumothorax is determined by pain, respiratory failure and circulatory disorders, the severity of which depends on the volume of air in the pleural cavity. The disease most often manifests suddenly, unexpectedly for the patient, however, in 20% of cases, an atypical, erased onset is noted. In the presence of a small amount of air, clinical symptoms do not develop, and a limited pneumothorax is detected during a planned fluorography.

In the case of an average or total closed pneumothorax, sharp stabbing pains in the chest appear, radiating to the neck and arm. There is shortness of breath, dry cough, feeling of lack of air, tachycardia, cyanosis of the lips, arterial hypotension. The patient sits, leaning his hands on the bed, his face is covered with cold sweat. Subcutaneous emphysema spreads along the soft tissues of the face, neck, torso, due to the ingress of air into the subcutaneous tissue.

With tension pneumothorax, the patient's condition is severe or extremely severe. The patient is restless, feels a sense of fear due to a feeling of suffocation, greedily catches air with his mouth. The heart rate increases, the skin becomes bluish in color, a collaptoid state may develop. The described symptomatology is associated with a complete collapse of the lung and a shift of the mediastinum to the healthy side. In the absence of emergency care, a tension pneumothorax can lead to asphyxia and acute cardiovascular failure.

Diagnosis of closed pneumothorax

A closed pneumothorax can be suspected by a pulmonologist based on the clinical picture and auscultatory findings, and finally confirmed by the results of X-ray diagnostics. On examination, smoothing of the intercostal spaces is determined, the backlog of half of the chest on the side of the lesion during breathing; with ascultation - weakening or absence of respiratory sounds; with percussion - tympanitis; on palpation of soft tissues with symptoms of subcutaneous emphysema - a characteristic crunch.

Differential Diagnosis

Differentiate closed pneumothorax from:

• uncomplicated lung cysts

The subsequent treatment of a closed pneumothorax can be performed by a conditionally conservative or surgical method. The first method involves a pleural puncture with simultaneous air evacuation or drainage of the pleural cavity with the imposition of drainage according to Bulau or an electrovacuum apparatus for active aspiration. A typical place for the installation of drainage is the II intercostal space in the midclavicular line.

In case of ineffectiveness of the puncture-drainage method or repeated relapses of closed pneumothorax, a thoraxoscopic or open intervention is performed to eliminate the root cause of the pathology. To prevent repeated cases of the disease, pleurodesis is carried out, leading to the formation of adhesions between the pleura and obliteration of the pleural fissure.

Closed pneumothorax prognosis

The prognosis of closed pneumothorax is closely related to its underlying cause. It is noted that idiopathic pneumothorax proceeds more favorably than symptomatic. The most dangerous are tension and bilateral pneumothorax, leading to respiratory and cardiovascular failure.

Conditions that complicate closed pneumothorax include relapse of the disease, pleurisy, pleural empyema, intrapleural bleeding, and the formation of a so-called rigid lung. With an unexplained or known, but unresolved cause of closed pneumothorax, relapses over 3 years are observed in half of the cases, after the elimination of the cause - only in 5%.

With a closed pneumothorax, air enters from the damaged lung or through the chest wall at the time of injury, after which the edges of the wound close and the air stops flowing into the cavity. The largest amount of air that has entered the pleural cavity almost does not disturb breathing and is gradually absorbed.

Open pneumothorax

With an open pneumothorax, the wound gapes, does not close, and the pleural cavity freely communicates with the surrounding space, with the external environment. In the pleural cavity, normal pressure is always negative (from 1 to 20 mm of water column). If atmospheric air enters one of the pleural cavities, which is under positive pressure, then the lung, due to its elasticity, contracts and does not take part in the act of breathing.

During inhalation, the mediastinum is pushed back to the healthy half of the chest due to a decrease in pressure. In addition, a healthy lung that expands during inhalation additionally sucks the mediastinum to its side. During exhalation, the reverse relationship occurs, and the mediastinum moves towards the pneumothorax. There are sharp pendulum-shaped oscillations of the mediastinum, which adversely affect the state of blood circulation.

Thus, with an open pneumothorax, the victim develops an extremely serious condition, which is due to the presence of a wound, irritation of nerve receptors, the influx of cold air, respiratory and circulatory disorders. More than half of the wounded develop severe pleuropulmonary shock.

Recognition of wounds with open pneumothorax is not difficult. When inhaling and exhaling, the noise of incoming and outgoing air is heard in the wound. The patient has a sharp shortness of breath, a drop in pulse and pressure.