Pneumothoraces during weaning from ventilation

Patients with severe acute respiratory distress syndrome or pneumonia who exhibit recurrent air leaks during the acute illness are often left with intrathoracic air collections during the weaning phase. Extensive areas of pulmonary fibrosis, combined with lung tethering, result in eccentric collections of residual air. Such collections are often not under tension and have no active air leak. In addition, fibrotic lung cannot be expanded to fill the space. Figure.5 illustrates multiple residual collections following acute respiratory distress syndrome, in one of which, anteriorly, is a functioning chest drain. In our experience, there is a diminishing return in attempting to access all these collections, and weaning, although protracted, can be successfully achieved despite their presence.

Fig. 5 Multiple residual collections following acute respiratory distress syndrome. Successful weaning was achieved without further drainage.

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