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Critical Care

, 9:R440

First Online: 22 June 2005Received: 16 March 2005Revised: 27 April 2005Accepted: 12 May 2005


IntroductionPneumothorax 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.

MethodsWe 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.

ResultsThe 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.

ConclusionIn 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.

AbbreviationsALIacute lung injury

APACHEAcute Physiology and Chronic Health Evaluation

ARDSacute respiratory distress syndrome

FiO2fraction of inspired oxygen

MAPmean airway pressure

ICUintensive care unit

PEEPpositive end-expiratory pressure

PIPpeak inspiratory pressure

SARSsevere acute respiratory syndrome.

Electronic supplementary materialThe online version of this article doi:10.1186-cc3736 contains supplementary material, which is available to authorized users.

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Autor: Hsin-Kuo Kao - Jia-Horng Wang - Chun-Sung Sung - Ying-Che Huang - Te-Cheng Lien


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