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Treating Pneumothorax: Surgery & Complications

Instructor: Nancy Kilmer

Nancy is a registered nurse with a bachelor of science in nursing degree.

Treatment for pneumothorax sometimes requires surgical treatment. When this is needed, there can be complications from the surgical procedure. Let's take a look at these complications and how to treat them.

Causes of Pneumothorax

Pneumothorax is a partial or complete collapse of a lung. Pneumothorax occurs when there is a break or rupture of one of the two layers of membrane (pleura), one that lines the chest cavity and one that provides a covering of the lung. The space between the layers fills with air, causing compression of the lung.

Normal lung vs. Pneumothorax
Pneumothorax

The causes of pneumothorax are varied. Spontaneous pneumothorax occurs for no obvious reason. However, it generally occurs in people with a history of heavy smoking or who experience a rupture of blebs. Blebs are small blisters on the surface of the lung that can rupture, causing air to build up in the space between the membranes.

Pneumothorax can also be caused by diseases that affects the lungs. These might be tumors, COPD (chronic obstructive pulmonary disease), asthma, or cystic fibrosis. Trauma to the chest, such as an external puncture or fractured ribs, can also cause pneumothorax.

Treatment Options

With pneumothorax, the patient becomes short of breath and experiences chest pain. There may also be the sensation of chest tightness in severe cases. The pressure is sometimes described as ''an elephant sitting on my chest'', causing the person to believe that they are having a heart attack. Symptoms can vary depending on how much of the lung is compressed. Generally, onset of symptoms is sudden and causes the patient to go to the emergency room. Initial treatment depends upon the severity of symptoms once the problem is diagnosed through a chest x-ray and the amount of lung compression is determined. Initial treatment steps include:

  • Adding oxygen and monitoring
  • Inserting a needle into the space between membranes to withdraw air
  • Placing a chest tube into the space between membranes until the symptoms resolve

If these measures fail and the patient does not improve (or they worsen), then surgery is required. There are several procedures that can be done:

  • Thoracoscopy is a method of inserting a tube with a camera through the chest wall to find the leak in the membrane so that it can be repaired.
  • Pleurodesis is a procedure that causes the layers of the membrane to stick together using medications so that air buildup cannot occur in the future.
  • Thoracotomy is a procedure in which a large incision is made to open the chest cavity to repair the problem when thoracoscopy is not successful.

Surgical Complications

Surgical procedures are not without the potential for complications. Complications can include:

Procedure Complication Cause
Thoracoscopy Lung puncture Misplacement of scope or instruments
Bleeding Puncture of blood vessels or bleeding at site of tissue sample (if taken)
Infection Break in sterile technique introducing bacteria into the chest
Pleurodesis Bleeding Puncture of blood vessels and irritation from pleurodesis medications
Infection Break in sterile technique introducing bacteria into the chest
Pain Medications for pleurodesis cause irritation of tissues
Thoracotomy Bleeding Puncture of blood vessels or bleeding at incision site
Infection Break in sterile technique introducing bacteria into the chest; incision infection
Pain Large incision into chest with severe pain afterward; ribs may have been separated to gain access to the lung
Pneumonia Pain in chest decreases deep breathing, increasing susceptibility to pneumonia

Management of Complications

The first line of defense against infection is prevention. Surgical procedures are done in the proper setting, using sterile techniques and taking precautions to maintain sterility. Proper wound care is also done, keeping incision lines clean and providing daily wound cleansing as needed to avoid contamination until the wound is sealed. The treatment for infection when it does occur is antibiotic therapy.

Bleeding during surgery is managed prior to closing the incision. If bleeding is noted after surgery, the cause is determined and treatment is based upon the amount of bleeding and whether or not it is expected to subside without intervention.

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