Key messages

• Indications for drainage of a pneumothorax in a critical care patient are usually obvious.

• Any deterioration in hemodynamics or gas exchange in a ventilated patient should raise the possibility of pneumothorax.

• Clinical evidence of tension pneumothorax mandates immediate drainage.

• A pneumothorax suspected clinically, and confirmed radiologically, should similarly be drained.

• In less obvious circumstances, more definitive imaging, such as by CT scanning, may identify an occult collection.

• In certain circumstances, particularly in the presence of small iatrogenic pneumothoraces, a conservative approach may be used but must be accompanied by vigilant observation and recognition of the risk of rapid deterioration.

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