Research

Pneumothorax and mortality in the mechanically ventilated SARS patients: a prospective clinical study

Hsin-Kuo Kao¹, Jia-Horng Wang², Chun-Sung Sung³, Ying-Che Huang³ and Te-Cheng Lien^4*

• * Corresponding author: Te-Cheng Lien kuohsink@ms67.hinet.net

Author Affiliations

¹ Attending physician, Department of Respiratory Therapy, Taipei Veterans General Hospital; Department of Medicine, Taoyuan Veterans Hospital; National Yang-Ming University School of Medicine, Taipei, Taiwan

² Attending physician and Chief of Department, Department of Respiratory Therapy, Taipei Veterans General Hospital; National Yang-Ming University School of Medicine, Taipei, Taiwan

³ Attending physician, Department of Anesthesiology, Taipei Veterans General Hospital; National Yang-Ming University School of Medicine, Taipei, Taiwan

⁴ Attending physician, Department of Respiratory Therapy, Taipei Veterans General Hospital; National Yang-Ming University School of Medicine, Taipei, Taiwan

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Critical Care 2005, 9:R440-R445 doi:10.1186/cc3736

Published: 22 June 2005

Abstract

Introduction

Pneumothorax often complicates the management of mechanically ventilated severe acute respiratory syndrome (SARS) patients in the isolation intensive care unit (ICU). We sought to determine whether pneumothoraces are induced by high ventilatory pressure or volume and if they are associated with mortality in mechanically ventilated SARS patients.

Methods

We conducted a prospective, clinical study. Forty-one mechanically ventilated SARS patients were included in our study. All SARS patients were sedated and received mechanical ventilation in the isolation ICU.

Results

The mechanically ventilated SARS patients were divided into two groups either with or without pneumothorax. Their demographic data, clinical characteristics, ventilatory variables such as positive end-expiratory pressure, peak inspiratory pressure, mean airway pressure, tidal volume, tidal volume per kilogram, respiratory rate and minute ventilation and the accumulated mortality rate at 30 days after mechanical ventilation were analyzed. There were no statistically significant differences in the pressures and volumes between the two groups, and the mortality was also similar between the groups. However, patients developing pneumothorax during mechanical ventilation frequently expressed higher respiratory rates on admission, and a lower PaO₂/FiO₂ ratio and higher PaCO₂ level during hospitalization compared with those without pneumothorax.

Conclusion

In our study, the SARS patients who suffered pneumothorax presented as more tachypnic on admission, and more pronounced hypoxemic and hypercapnic during hospitalization. These variables signaled a deterioration in respiratory function and could be indicators of developing pneumothorax during mechanical ventilation in the SARS patients. Meanwhile, meticulous respiratory therapy and monitoring were mandatory in these patients.