Pneumothoraces in poorly compliant lungs

Paradoxically, pneumothoraces which occur in the most severely compromised patients may be difficult to identify. Acute respiratory distress syndrome patients with static pulmonary compliance values below 15 ml/cmH2O and intrapulmonary shunt above 50 per cent may show little change in already grossly disordered gas exchange when pneumothoraces occur. The lungs are extremely stiff and do not collapse readily, and therefore the volume effects of relatively small collections may result in hemodynamic depression before gas exchange deteriorates. The early signs of pneumothorax in such patients may be subtle ( T.a.b!e.l), and most reflect hemodynamic changes. The non-uniformity of changes in commonly measured hemodynamic indices in the presence of tension pneumothorax has recently been highlighted (Beards.and Lipman...1994)

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Table 1 Early subtle signs of pneumothorax in patients with low pulmonary compliance

Pressure-controlled ventilation is widely used in acute respiratory failure, particularly in acute respiratory distress syndrome. An early sign of pneumothorax when this form of pressure-limited ventilation is employed is the inevitable decrease in tidal and minute volume caused by the pneumothorax-induced decrease in pulmonary compliance.

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