Pneumothorax: An analysis of 2000 incident reports

Eighteen (1%) of the first 2000 incidents reported to the Australian Incident Monitoring Study (AIMS) involved actual or suspected pneumothoraces; 17 were confirmed. Eleven of the patients were seriously ill beforehand. Four developed tension pneumothoraces, and in 2 incidents (1 tension) the pneumothoraces were bilateral. Nine of the 17 were iatrogenic; 6 (35%) followed neck vein cannulation, and 3 (18%) were surgical complications of tracheotomies. No death was attributed to a pneumothorax. In 8 of the 17 incidents diagnostic delay or difficulties occurred. Contributing factors identified included urgency, distorted anatomy, failure to check and haste on the part of the anaesthetist. Desaturation detected by pulse oximetry and hypotension detected by invasive blood pressure monitoring warned the anaesthetist on 2 occasions each. Indications for central vein cannulation or trans-tracheal airway manoeuvres must be firm. Such procedures should always be followed by a closely scrutinised erect chest X-ray as soon as practicable. The possibility of a pneumothorax must always be considered when unexpected cardiorespiratory deterioration occurs.