Closed pneumothorax: a reason to call an ambulance. Emergency care for closed and open pneumothorax Valvular or tension pneumothorax

Closed pneumothorax– an acute, life-threatening disease. But this is the most safe look disease, as it often has the opportunity for spontaneous resorption. This promotes expansion of the lung to its original volume and full restoration its functions. There is a closed form of the disease with damage to the tissues of the pleura, lung, bronchi.

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Definition

Closed pneumothorax – acute condition, in which an accumulation of air forms in the pleural cavity. At the same time, the relationship with external environment absent, the volume of trapped air does not increase.

Spreading

Closed pneumothorax is more common in young men under 40, tall and thin.

They account for more than 70% of all recorded cases of the disease. The risk of pneumothorax is higher in people who smoke, as well as those with congenital or acquired pulmonary diseases.

Origin

If the lung or bronchus is damaged, air escapes from them and accumulates in pleural cavity. The pressure inside the pleura increases sharply. As a result, the lung tissues are compressed partially or completely - the degree of compression is influenced by the volume of accumulated air.

Causes

Rupture of pulmonary or bronchial tissues occurs for the following reasons:

• Mechanical injuries- the main reason. Injuries can occur in a car accident, hitting the ground during a fall, or during a fight;
• chronic lung diseases– , COPD, ;
• congenital pathologies of the lungs and pleura– leading to their ruptures during intense physical and respiratory stress;
• surgical procedures– ventilation of the lungs.

Symptoms of closed pneumothorax

With a small amount of accumulated air, signs may be subtle or absent altogether. The main symptoms of closed pneumothorax:

• Chest pain– sharp, stabbing;
• sudden shortness of breath– rapid, labored breathing;
• subcutaneous emphysema– as a result of tissue injury from broken ribs;
• tachycardia;
• cyanosis– cyanosis.

Types of disease

Types of closed pneumothorax are determined by the degree of collapse of the lung:

• Small– the lung has fallen by a third. The least dangerous, often self-resolving type;
• average– collapse of the lung by half;
• big– the lung collapses completely. Severe appearance, threatening the appearance of complications (pleurisy, bleeding in the pleura) and death as a result of hypoxia.

Diagnostics

The primary diagnosis is established on the spot when symptoms are detected, the final one is in the pulmonology department:

• History taking– the presence of chronic diseases or injuries is determined;
• clinical examination– identification of characteristic symptoms;
• auscultation- when listening to respiratory noises, their decrease is observed up to their complete absence;
• x-ray examination- the most reliable method. There is no pulmonary pattern in the area of ​​pneumothorax. A shift of the trachea, esophagus, large vessels and heart to the undamaged side is visible with a large volume of air trapped;
• thoracoscopy– examination of the pleural cavity to determine the size of the damage
• pleural puncture– allows you to determine the amount of trapped air and carry out therapeutic procedures to remove it.

Differential diagnosis

Closed pneumothorax is differentiated from the following diseases:

• Using manometry– with open and valve pneumothorax. At closed illness pressure is constant;
• using an x-ray or computed tomography - pleurisy, pericarditis, myocardial infarction, hemothorax.

Treatment of closed pneumothorax

Treatment consists of emergency emergency care and subsequent qualified treatment.

First aid

First aid is provided as an emergency, immediately when symptoms appear. Delay is unacceptable!

The following actions are required:

• Urgent ambulance call by phone 03, 112;
• opening windows, vents for fresh air supply;
• calming the patient;
• giving him a comfortable half-sitting position.

Qualified help

An ambulance immediately transports the patient to surgery department, better - to a pulmonology hospital. There, depending on the degree of the disease, the patient is treated:

• Strict bed rest is established in the floor sitting position;
• for small pneumothorax without obvious violations of respiratory and cardiac activity - symptomatic therapy (antitussives, painkillers, heart drugs);
• oxygen therapy– using an oxygen cylinder;
• puncture- using a tube with a long needle, the pleural cavity is freed from air, which creates a negative pressure in it, which is necessary for normal breathing;
• thoracotomy of the pleural cavity– if puncture is ineffective for expanding the lung;
• operation– if the lung does not expand after puncture and drainage, in case of relapses or complications.

Prevention

There are no specific preventive measures.

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Primary

Based on strengthening the body and following general rules:

• To give up smoking;
• regular long-term diet;
• breathing exercises;
• full treatment for illnesses respiratory system;
• avoiding injury chest.

Secondary

In order to prevent relapses, the following measures are taken:

• Pleurodesis– to avoid relapses, artificially induce the formation of adhesions using silver nitrate, talc, glucose;
• surgical removal causes of the disease.

Forecast

In most cases, the prognosis is favorable. In the case where the cause of the development of closed pneumothorax is chronic illness lungs, the prognosis depends on the nature of the cause.

Closed pneumothorax is an acute, life-threatening disease. In its development it is necessary emergency assistance first aid and subsequent hospitalization. In hospitals, pulmonologists and thoracic surgeons treat this disease.

Pneumothorax is a pathological condition in which air enters the pleural cavity, causing the lung to partially or completely collapse. As a result of collapse, the organ cannot perform the functions assigned to it, so gas exchange and oxygen supply to the body suffers.

Pneumothorax occurs when the integrity of the lungs or chest wall is compromised. In such cases, often, in addition to air, blood enters the pleural cavity and develops hemopneumothorax. If the thoracic cavity is damaged during a chest injury lymphatic duct– observed chylopneumothorax.

In some cases, with a disease that provokes pneumothorax, exudate accumulates in the pleural cavity - it develops exudative pneumothorax. If the process of suppuration starts further, it comes pyopneumothorax.

Causes of occurrence and mechanisms of development

Not in the lung muscle tissue, so it cannot straighten itself to allow breathing. The inhalation mechanism is as follows. IN in good condition the pressure inside the pleural cavity is negative - less than atmospheric. When the chest wall moves, the chest wall expands due to negative pressure in the pleural cavity lung tissue“picked up” by the traction inside the chest, the lung expands . Next, the chest wall moves into reverse direction, the lung returns to its original position under the influence of negative pressure in the pleural cavity. This is how a person performs the act of breathing.

If air enters the pleural cavity, the pressure inside it increases, the mechanics of lung expansion are disrupted - a full act of breathing is impossible.

Air can enter the pleural cavity in two ways:

• in case of damage to the chest wall with a violation of the integrity of the pleural layers;
• with damage to the mediastinal organs and lungs.

The three main parts of pneumothorax that cause problems are:

• the lung cannot expand;
• air is constantly sucked into the pleural cavity;
• the affected lung swells.

The inability to expand the lung is associated with the re-entry of air into the pleural cavity, blockage of the bronchus due to previously noted diseases, and also if the pleural drainage was installed incorrectly, which is why it does not work effectively.

note

Air suction into the pleural cavity can pass not only through the formed defect, but also through the hole in chest wall made for installing drainage.

Symptoms of pneumothorax

The degree of manifestation of pneumothorax symptoms depends on how much the lung tissue has collapsed, but in general they are always pronounced. The main signs of this pathological condition:

Non-traumatic, mild pneumothorax can often pass without any symptoms.

Diagnostics

If the symptoms described above are observed after the fact of injury, and a defect in the chest tissue is detected, there is every reason to suspect pneumothorax. Non-traumatic pneumothorax is more difficult to diagnose - this will require additional instrumental research methods.

One of the main methods for confirming the diagnosis of pneumothorax is the chest organs when the patient is in a supine position. The images show a decrease in the lung or its complete absence(in fact, under air pressure, the lung is compressed into a lump and “merges” with the mediastinal organs), as well as displacement of the trachea.

Sometimes radiography can be uninformative - in particular:

• for small pneumothorax;
• when adhesions have formed between the lung or chest wall, partially holding the lung from collapsing; this happens after expressed lung diseases or operations regarding them;
• because of skin folds, intestinal loops or stomach - confusion arises as to what is actually revealed in the image.

In such cases, other diagnostic methods should be used - in particular, thoracoscopy. During it, a thoracoscope is inserted through a hole in the chest wall, with its help the pleural cavity is examined, the fact of collapse of the lung and its severity is recorded.

The puncture itself, even before the insertion of the thoracoscope, also plays a role in diagnosis - with its help it is obtained :

• with exudative pneumothorax - serous fluid;
• with hemopneumothorax - blood;
• with pyopneumothorax - pus;
• with chylopneumothorax - a liquid that looks like a fat emulsion.

If air escapes through the needle during puncture, this indicates a tension pneumothorax.

Also, puncture of the pleural cavity is carried out as an independent procedure - if a thoracoscope is not available, but it is necessary to carry out a differential (distinctive) diagnosis with other possible pathological conditions chest and pleural cavity in particular. The extracted contents are sent for laboratory testing.

To confirm pulmonary heart failure, which manifests itself with tension pneumothorax, do.

Differential diagnosis

In its manifestations, pneumothorax may be similar to:

• emphysema - bloating lung tissue(especially in young children);
• hernia esophageal opening diaphragms;
• large lung cyst.

The greatest clarity in diagnosis in such cases can be obtained using thoracoscopy.

Sometimes the pain with pneumothorax is similar to pain with:

• diseases of the musculoskeletal system;
• oxygen starvation of the myocardium;
• diseases of the abdominal cavity (may radiate to the stomach).

In this case, put correct diagnosis Research methods that are used to detect diseases of these systems and organs, as well as consultation with related specialists, will help.

Treatment of pneumothorax and first aid

In case of pneumothorax it is necessary:

• stop the flow of air into the pleural cavity (to do this, it is necessary to eliminate the defect through which air enters it);
• Remove existing air from the pleural cavity.

There is a rule: open pneumothorax should be converted to closed, and valve pneumothorax to open.

To carry out these measures, the patient should be immediately hospitalized in the thoracic or, at a minimum, surgical department.

Before x-ray examination organs chest cavity carry out oxygen therapy, since oxygen enhances and accelerates the absorption of air by the pleura. In some cases, primary spontaneous pneumothorax does not require treatment - but only when no more than 20% of the lung has collapsed, and there is no damage to the respiratory system pathological symptoms. In this case, constant x-ray monitoring should be carried out to make sure that air is constantly being sucked in and the lung is gradually expanding.

With severe pneumothorax with a significant decrease lung air need to be evacuated. It can be done:

Using the first method, you can quickly relieve the patient from the consequences of pneumothorax. On the other side, quick removal air from the pleural cavity can lead to stretching of the lung tissue, which was previously in a compressed state, and its swelling.

Even if after spontaneous pneumothorax lung thanks to drainage it has straightened out, the drainage can be left for a while to be on the safe side in case of recurrent pneumothorax . The system itself is adjusted so that the patient can move (this is important for the prevention of congestive pneumonia and thromboembolism).

Tension pneumothorax is regarded as a surgical emergency requiring emergency decompression - immediate removal of air from the pleural cavity.

Prevention

Primary spontaneous pneumothorax can be prevented if the patient:

• stop smoking;
• will avoid actions that could lead to rupture of weak lung tissue - jumping into water, movements associated with stretching the chest.

Prevention of secondary spontaneous pneumothorax comes down to the prevention of diseases in which it occurs (described above in the section “Causes and development of the disease”), and if they occur, to their qualitative cure.

Prevention of chest injuries automatically becomes prevention of traumatic pneumothorax. Menstrual pneumothorax is prevented by treating endometriosis, iatrogenic - by improving practical medical skills.

Forecast

With timely recognition and treatment of pneumothorax, the prognosis is favorable. The most serious risks to life occur with tension pneumothorax.

After a patient first experiences spontaneous pneumothorax, relapse may occur in half of patients over the next 3 years . This high rate of recurrent pneumothorax can be prevented by using treatments such as:

• video thoracoscopic surgical intervention, during which the bullae are sutured;
• pleurodesis (artificially induced pleurisy, as a result of which adhesions are formed in the pleural cavity, holding the lung and chest wall together

Pneumothorax of the lungs is the appearance of air accumulation in the pleural cavity. This is fraught with serious consequences, the lungs cannot function normally, and respiratory function is impaired. This condition is becoming more common these days. Occurs in patients aged 20 - 40 years.

The injured person needs to begin providing emergency care as soon as possible, since pneumothorax can be fatal. In more detail, what kind of disease this is, what are the causes and symptoms, as well as first aid for pneumothorax and effective treatment- further in the article.

Pneumothorax: what is it?

Pneumothorax is an excessive accumulation of air between the pleural layers, leading to short-term or long-term impairment of the respiratory function of the lungs and cardiovascular failure.

In pneumothorax, air can penetrate between the layers of the visceral and parietal pleura through any defect on the surface of the lung or in the chest. Air penetrating into the pleural cavity causes an increase in intrapleural pressure (normally it is lower than atmospheric pressure) and leads to the collapse of part or the whole lung (partial or complete collapse of the lung).

Patient with pneumothorax experiences sharp pain in the chest, breathing quickly and shallowly, with shortness of breath. Feels “short of air.” Appears pale or cyanotic skin, in particular faces.

• In the international classification of diseases ICD 10, pneumothorax is located: J93.

Classification of the disease

There are two types of pneumothorax: different types depending on the origin and communication with the external environment:

1. open, when gas or air enters the pleural cavity from the external environment through defects in the chest - injuries, while there is depressurization of the respiratory system. If an open pneumothorax develops, it changes and this leads to the fact that the lung collapses and no longer performs its functions. Gas exchange in it stops, and oxygen does not enter the blood;
2. Closed - no contact with environment. Subsequently, there is no increase in the amount of air and theoretically this type can resolve spontaneously (it is the mildest form).

By distribution type:

• unilateral. Its development is indicated when only one lung collapses;
• bilateral. The victim's right and left lobes of the lungs collapse. This condition is extremely life-threatening for a person, so he needs to begin providing emergency care as soon as possible.

Also distinguished:

• Traumatic pneumothorax occurs as a result of penetrating injury to the chest or damage to the lung (for example, fragments of broken ribs).
• spontaneous pneumothorax, occurring without any previous disease or latent disease;
• Tension pneumothorax is a condition when air enters the pleural cavity, but there is no way out; the cavity is filled with gas. A complete collapse of the lung occurs and air does not enter it even with a deep breath.
• secondary - arising as a complication of pulmonary or extrapulmonary pathology,
• artificial or iatrogenic - created by doctors if certain manipulations are necessary. This may include: pleural biopsy, insertion of a catheter into the central veins.

By the volume of air that entered the cavity between the layers of the pleura, they recognize the following types pneumothorax:

• partial (partial or limited) – lung collapse is incomplete;
• total (complete) – a complete collapse of the lung has occurred.

According to the presence of complications:

• Complicated (bleeding, mediastinal and subcutaneous emphysema).
• Uncomplicated.

Causes

Etiological factors that can lead to the development of pneumothorax are divided into three groups:

• Diseases of the respiratory system.
• Injuries.
• Medical manipulations.

Causes of spontaneous pneumothorax of the lung can be (arranged in descending order of frequency):

• Bullous lung disease.
• Pathology respiratory tract(chronic obstructive pulmonary disease, cystic fibrosis, status asthmaticus).
• Infectious diseases (Pneumocystis,).
• Interstitial lung diseases (sarcoidosis, idiopathic pneumosclerosis, Wegener's granulomatosis, lymphangioleiomyomatosis, tuberous sclerosis).
• Diseases connective tissue(, ankylosing spondylitis, polymyositis, dermatomyositis, scleroderma, Marfan syndrome).
• Malignant neoplasms (sarcoma, lung cancer).
• Breast endometriosis.

Symptoms of pneumothorax of the lungs

The main manifestations of pneumothorax are due to sudden appearance and the gradual accumulation of air in the pleural cavity and compression of the lung, as well as displacement of the mediastinal organs.

General symptoms in adults:

• the patient has difficulty breathing and has shallow, rapid breathing;
• cold, sticky sweat appears;
• attack of dry cough;
• the skin acquires a bluish tint;
• cardiopalmus; sharp pain in the chest;
• fear; weakness;
• decrease in blood pressure;
• subcutaneous emphysema;
• the victim takes a forced position - sitting or half-sitting.

The severity of pneumothorax symptoms depends on the cause of the disease and the degree of compression of the lung.

Lack of timely assistance most often leads to the development of complications that threaten the patient’s life.

Complications

Complications of pneumothorax occur frequently, according to statistics - half of all cases. These include:

• pleural empyema - purulent pleurisy, pyothorax;
• intrapleural bleeding as a result of tearing of the lung tissue, serous-fibrinous pneumopleurisy with the formation of a “rigid” lung.

With valvular pneumothorax, the formation of subcutaneous emphysema is not excluded - accumulations are not large quantity air under the skin in subcutaneous fat.

Long-term pneumothorax often ends with the replacement of lung tissue with connective tissue, shrinkage of the lung, loss of elasticity, development of pulmonary and heart failure, and death.

Diagnostics

Already upon examination of the patient, characteristic features pneumothorax:

• the patient takes a forced sitting or semi-sitting position;
• the skin is covered with cold sweat, shortness of breath, cyanosis;
• expansion of the intercostal spaces and chest, limitation of chest excursion on the affected side;
• decline blood pressure, tachycardia, displacement of the borders of the heart to the healthy side.

From instrumental methods The gold standard examination is a chest x-ray in a sitting or standing position. To diagnose pneumothorax with a small amount of air, fluoroscopy or expiratory radiography is used.

The final diagnosis is made based on the results of an x-ray or tomography, on the basis of which pneumothorax is differentiated from the following diseases:

• Asphyxia;
• pleurisy;
• myocardial infarction;
• diaphragmatic hernia.

First aid

Pneumothorax in valvular or open form is one of the emergency conditions, the occurrence of which should immediately call an ambulance. Then be sure to do the following:

• stop the process of filling the victim’s pleural cavity with air;
• stop bleeding.

First emergency aid for any type of pneumothorax is not only the use of drug therapy, but also compliance with a certain regime.

Patients with pneumothorax are hospitalized in surgical hospital(if possible in specialized pulmonology departments). Medical assistance consists of performing a puncture of the pleural cavity, evacuating air and restoring negative pressure in the pleural cavity.

Treatment of pneumothorax

Treatment for pneumothorax begins in the ambulance. Doctors do:

• oxygen therapy;
• anesthesia (this is an important point in treatment; painkillers are necessary for the patient both at the stage of lung collapse and during its expansion);
• remove the cough reflex;
• a pleural puncture is performed.

Depending on the type of disease, treatment will be as follows:

1. Small closed limited pneumothorax– most often does not require treatment. It spontaneously resolves after a few days without causing serious disorders;
2. when closed, the trapped air is aspirated using a puncture system;
3. if open, first transfer it to closed, suturing the hole. Next, the air is sucked out through the puncture system;
4. in case of valve - transfer it to open view using a thick needle and then treated surgically;
5. with recurrent – surgical removal its reasons. For patients over 50 years of age with recurrent pneumothorax, it is preferable to use not a simple pleural puncture, but the installation of a drainage tube and active aspiration of air.

Treatment and rehabilitation last from 1-2 weeks to several months, it all depends on the cause.

Rehabilitation after pneumothorax

1. After leaving the hospital, a patient who has suffered a pulmonary pneumothorax must refrain from any physical activity for 3-4 weeks.
2. Airplane flights are prohibited for 2 weeks after treatment.
3. You should not engage in parachute jumping or diving - all this causes pressure changes.
4. Smoking is strictly forbidden, you should definitely quit dangerous habit.
5. Doctors also advise you to undergo screening for tuberculosis and COPD.

In 20% of cases, patients experience a relapse of the pathology, especially if it is caused primary disease. A person’s condition is considered dangerous when the pleural cavity is filled with air on both sides. This usually entails acute disorder breathing and death.

The bilateral form of pneumothorax is characterized by a favorable outcome only in 50% of cases.

Forecast

Any pneumothorax of the lungs requires immediate hospitalization of the patient in a surgical hospital for surgical treatment. The sooner a patient diagnosed with symptoms of the disease is sent to the hospital, the greater the chance of successful treatment.

Pneumothorax is a pathology whose name comes from Greek words– thorax and pneuma (chest and air). An acute disease, which is quite common these days, is a concentration of air in the pleural cavity. The patient requires immediate medical attention.

What is pneumothorax?

Pneumothorax is a life-threatening disease when air enters places in the body where it should not normally be - into the pleural cavity.

Air trapped in the pleural cavity can provoke lung collapse, which has partial or full form. The appearance of the pathology can be spontaneous or develop as a result of a person’s existing lung diseases, medical procedures, or injuries. The ventilation work of the lungs is disturbed, they are compressed, respiratory failure and oxygen deficiency. The organs of the mediastinum (heart, large vessels) are displaced, and disruptions in blood circulation processes are noted.

Varieties of pneumothorax of the lungs

The absence or presence of connection with the external environment divides this pathology into the following types:

Causes of pneumothorax of the lung

Spontaneous, traumatic, iatrogenic - these are the main reasons why a person may develop this disease.

Spontaneous reasons

A disease when the integrity of the pleura is suddenly disrupted and its cavity is filled with air. Moreover, the person does not receive external injuries. Given this reason, there is a primary or secondary pneumothorax.

The appearance of primary pathology has no obvious reasons. To belong to male, high growth, presence of unhealthy habits (smoking), 25–30 years are the main risk factors. The disease is very rarely observed after 40, women suffer from it even less often.

The causes of spontaneous disease can be the following pathologies:

Spontaneous secondary pneumothorax appears due to lung pathology. These are possible:

• malignant tumors (sarcoma, lung cancer);
• lung diseases that injure connective tissue (lymphangioleiomyomatosis, sarcoidosis, tuberous sclerosis, idiopathic pneumosclerosis);
• systemic diseases connective tissue, which include lung lesions ( rheumatoid arthritis, dermatomyositis, Marfan syndrome, polymyositis, systemic scleroderma);
• infectious diseases lungs (pneumonia due to HIV, tuberculosis) lung abscess;
• respiratory tract diseases (COPD, bronchial asthma, cystic fibrosis).

Most often, this pathology is encountered in old age.

Iatrogenic pneumothorax

The main source of this form is various medical procedures. The disease can be activated by:

• ventilation;
• installation of a central (venous) catheter;
• cardiopulmonary resuscitation;
• puncture of the pleural cavity;
• performing a pleural biopsy.

Traumatic pneumothorax

Injuries and wounds of the chest are the main source of this form of pathology:

• penetrating chest wound(stab and gunshot wounds that cause lung rupture);
• closed injury breasts, which was obtained as a result of a fight, a fall from a height, etc.

Pneumothorax: Symptoms of the disease

The disease can be manifested by such symptoms, which will depend on the specific type of disease, the severity of the passage, the absence or presence of complications and other factors:

Symptoms of spontaneous pneumothorax

Almost all patients diagnosed with primary spontaneous pneumothorax note chest pain that appears from the side of the defect, as well as sudden shortness of breath. The intensity of pain syndromes differs - from insignificant to very strong. Many patients describe the pain at first as sharp, and then as aching or dull. Clinical picture lasts no more than a day, regardless of whether the disease is treated.

When a patient has a secondary spontaneous pneumothorax, he will certainly have shortness of breath, regardless of how much air has entered the pleural cavity. As a rule, there is also pain that occurs on the deformed side. Possible addition of hypotension and hypoxemia.

Symptoms of valvular pneumothorax

The patient notices a sharp pain in the chest and is in an excited state. Pain sensations can be stabbing or stabbing in nature, radiating to the abdominal cavity, shoulder, and shoulder blade. Shortness of breath, cyanosis, and weakness immediately develop.

Symptoms in newborns

Symptoms of pneumothorax in children under one year old may look like this:

Complications

According to statistics, the consequences of pneumothorax were observed in approximately 55% of patients:

• Air entering the fiber, compressing the heart and large vessels.
• Pleurisy (inflammation of the pleura). Sometimes accompanied by the appearance of adhesions that disrupt the expansion of the lung.
• Subcutaneous emphysema is a pathology when air passes into the subcutaneous fat.
• Intrapleural bleeding.
• Death. Possible in severe cases - a penetrating wound to the chest, a significant volume of damage.

Pneumothorax: Treatment of the disease

Pneumothorax is life-threatening for the patient, so treatment begins before arriving at the hospital.

On the way to the hospital

This produces:

Hospital treatment

Patients with pneumothorax must be hospitalized. Health care consists of forming negative pressure in the pleural cavity, removing air, and puncturing the pleural cavity. Treatment will depend on the type of disease.

Expectant conservative treatment relevant when we're talking about about a small limited closed pneumothorax. The patient is given painkillers and rest is ensured. If necessary, air is aspirated using a puncture system. Pleural puncture is performed on the injured side in the second intercostal space along the midclavicular line.

In the total form, to quickly expand the lung and prevent a shock reaction, drainage is installed into the pleural cavity, followed by passive (according to Bulau) or active (using an electric vacuum device) air aspiration.

At open pneumothorax the main task is to translate it into a closed form. Why the wound is sutured, the entry of air into the pleural cavity is stopped. Then they carry out manipulations that are similar to the closed form.

When a patient has a valvular pneumothorax, it is necessary to reduce the pressure inside the pleura. First, it is opened using a puncture, then surgical treatment is performed.

Recurrent spontaneous pneumothorax, which is provoked by bullous emphysema, is treated with surgery.

Anesthesia

This is an important point in the treatment of pneumothorax; painkillers are necessary for the patient both at the stage of lung collapse and during its expansion. To exclude recurrence of the disease, pleurodesis is performed with a glucose solution, talc, silver nitrate and other sclerosing agents. This is how the adhesive process is deliberately activated in the pleural cavity.

Prevention and rehabilitation

A patient who has suffered pneumothorax, after discharge from the hospital, is required to refrain from any significant exercise for a month. After treatment, flights by plane are prohibited for 2 weeks. Diving and parachute jumping are contraindicated - all these activities cause pressure changes. Smoking is completely prohibited, you definitely need to quit such a dangerous habit. Doctors also recommend screening for COPD and tuberculosis.

Unfortunately, there are no methods of prevention that can provide reliable protection against this disease, but certain actions can still be taken:

• Examination for the presence of lung diseases, their timely treatment.
• Quitting cigarettes.
• Breathing exercises.
• Carrying out on fresh air lots of time.

Pneumothorax is not a death sentence at all; many patients successfully cope with this disease. uncomplicated stages of the disease timely treatment have a favorable prognosis, however, not the absence of recurrence.

According to statistics, spontaneous primary pneumothorax returns to patients in about 35% of cases, as a rule, this happens already in the first 6 months after treatment. In the case of spontaneous secondary pneumothorax, recurrence rates are even higher - up to 50%. The sooner a patient diagnosed with symptoms of pneumothorax is sent to the hospital, the greater the chance for successful treatment.

Pneumothorax of the lung dangerous pathology, in which air penetrates where physiologically it should not be - into the pleural cavity. This condition is becoming more common these days. The injured person needs to begin providing emergency care as soon as possible, since pneumothorax can be fatal.

The air that accumulates in the pleural cavity is the cause of the collapse of the lung - complete or partial. In some cases, spontaneous pneumothorax may develop. Also, the disease can develop due to diseases already existing in the human body, medical procedures or injuries (traumatic pneumothorax).

As a result of a massive accumulation of air, the ventilation capacity of the lungs is significantly reduced, they are compressed, and hypoxia is observed. As a result of this, the patient begins. The air in the pleural cavity also causes the displacement of large vessels, the heart, and the alveolar process. As a result, the blood circulation in the sternum is disrupted.

Kinds

Types of pneumothorax depending on the presence or absence of connection with the environment:

• open pneumothorax. If it develops, depressurization of the respiratory system occurs due to injury to the chest. Through the resulting hole, air gradually leaks into the pleural cavity during the act of breathing. Normally, the pressure in the chest is negative. If an open pneumothorax develops, it changes and this leads to the fact that the lung collapses and no longer performs its functions. Gas exchange in it stops, and oxygen does not enter the blood;
• closed pneumothorax. This type in medicine it is considered the simplest. As a result of the progression of closed pneumothorax, a certain amount of gas accumulates in the pleural cavity, but its volume is stable, since the resulting defect closes itself. Air can leave the pleural cavity on its own. In this case, the lung, which was compressed due to its accumulation, is leveled out and the respiratory function is normalized;
• tension pneumothorax. It is also called valvular pneumothorax in medical circles. This type of disease is the most dangerous and severe. A valve mechanism is formed in the chest, this leads to the fact that air enters the pleural cavity when inhaling, but does not leave it when exhaling. The pressure in the cavity will gradually increase, which will lead to displacement of the mediastinal organs, disruption of their functioning and to pleuropulmonary shock. With a tension pneumothorax, air enters the pleural cavity through the wound.

Classification according to the presence or absence of complications:

• uncomplicated pneumothorax. In this case, no complications develop against the background of the development of pathology;
• complicated. As a result of the development of open, valve or closed pneumothorax, the following complications occur: bleeding (possible hemothorax or hydropneumothorax).

By distribution type:

• unilateral. Its development is indicated when only one lung collapses;
• bilateral. The victim's right and left lobes of the lungs collapse. This condition is extremely life-threatening for a person, so he needs to begin providing emergency care as soon as possible.

By air volume:

• full. The lung collapses completely. It is especially dangerous if the victim has a complete bilateral pneumothorax, since a critical failure of respiratory function occurs, which can result in death;
• parietal. This type is typical for closed form illness. In this case, air fills only a small part of the pleura and the lung is not fully expanded;
• encysted. This species does not pose a particular danger to the patient's life. In this case, adhesions form between the sheets of pleura, which limit the area of ​​pneumothorax.

Particularly worth highlighting is hydropneumothorax. In this case, not only air, but also liquid accumulates in the pleural cavity. This leads to rapid collapse of the lung. Therefore, if such a pathology is detected, the victim should be taken to a medical facility as soon as possible.

Pneumothorax is a disease that affects not only adults. It can even develop in newborns. For them this state is very dangerous and without timely and adequate assistance leads to fatal outcome. In newborns, pneumothorax occurs due to many reasons, but the tactics for eliminating it are the same as in adults.

Causes

All causes of pneumothorax are conventionally divided into three groups - spontaneous, iatrogenic and traumatic.

Spontaneous pneumothorax

The development of spontaneous pneumothorax is said to occur if the integrity of the pleura is suddenly disrupted and filled with air. External injuries it is not observed. Spontaneous pneumothorax can be primary or secondary.

Causes of primary spontaneous pneumothorax:

• high growth;
• smoking;
• being male;
• weakness of the pleura, genetically determined;
• pressure changes during diving, flying in an airplane, diving.

Causes of secondary spontaneous pneumothorax:

• respiratory tract pathologies;
• lung diseases, the development of which causes trauma to the connective tissue;
• ailments infectious nature affecting the lungs;
• Marfan syndrome;
• systemic

Iatrogenic pneumothorax

The main reason for the progression of this type is various medical procedures. "Launch" pathological process the following procedures:

• lung ventilation;
• pleural biopsy;
• installation of a central catheter;
• puncture of the pleural cavity;
• cardiopulmonary resuscitation.

Traumatic pneumothorax

Traumatic pneumothorax develops as a result of trauma to the chest, as a result of which the integrity of the organ is disrupted:

• closed injury. It can occur when falling from a height, falling on a hard object, during a fight, etc.;
• wound of the chest that violated the integrity of its tissues – gunshot wounds, wounds with piercing and cutting objects.

Pneumothorax in newborns

Pneumothorax in newborns is not a rare occurrence. It can occur during childbirth due to clogging of the baby's airways with mucus and amniotic fluid.

• pulmonary forced ventilation;
• rupture of a lung abscess;
• increased crying of a newborn can also cause rupture of the pleural commissure;
• rupture of a congenital or acquired cyst;
• genetic pathology of the lungs.

Symptoms

Symptoms of pneumothorax depend on the type of disease, the severity of its course, and the presence or absence of complications. The general symptoms of the disease are:

• the patient has difficulty breathing and has shallow, rapid breathing;
• cold, sticky sweat appears;
• attack of dry cough;
• the skin acquires a bluish tint;
• cardiopalmus;
• sharp pain in the chest;
• fear;
• weakness;
• decrease in blood pressure;
• subcutaneous emphysema;
• the victim takes a forced position - sitting or half-sitting.

In patients with spontaneous pneumothorax Chest pain is observed, which is more severe due to the development of the disease. There is also a sudden onset of shortness of breath. At first painful sensations sharp, but gradually they become dull and aching. In the case of spontaneous pneumothorax, hypotension and hypoxemia are observed. The skin may acquire a bluish tint. In case of spontaneous pneumothorax, the patient should be immediately taken to the hospital.

Symptoms of valvular pneumothorax are very pronounced. The patient is agitated and complains of sharp pain in the chest. Pain of a dagger or stabbing nature. It can radiate to the abdominal cavity (pain occurs in the intestines), shoulder, and shoulder blade. Weakness, shortness of breath, and cyanosis of the skin are rapidly increasing. Without rendering emergency assistance the patient faints.

Symptoms of pneumothorax in newborns and children under one year of age are also very pronounced. Observed:

• anxiety;
• the newborn is excited;
• dyspnea;
• subcutaneous crepitus on the neck and torso;
• puffiness of the face;
• labored breathing.

Urgent Care

Valvular or open pneumothorax is the most dangerous forms illness, the development of which must immediately call ambulance. Next, you need to provide first aid for pneumothorax yourself:

• stop the process of air entering the pleural cavity;
• stop bleeding.

For this purpose, first apply a sealed bandage to the chest. To seal the wound as much as possible, a plastic bag is placed on top of the bandage. The patient is moved to exalted position. In order to prevent painful shock, they give him to take analgin or aspirin. It is better to inject drugs directly into the muscle.

Treatment

Treatment for pneumothorax begins in the ambulance. Doctors do:

• oxygen therapy;
• anesthesia;
• remove the cough reflex;
• a pleural puncture is performed.

In a hospital setting, the main point in the treatment of pneumothorax is the removal of air that has accumulated in the pleural cavity. For this purpose, pleural puncture or drainage with active or passive air aspiration is performed. Next, it is important to convert the open pneumothorax to a closed one. For this purpose, the wound is sutured. Until complete recovery, the patient will need to stay in the hospital under the constant supervision of doctors.

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