I have been experiencing difficulty locating credible information on the contrindications of CPAP usage for patients with a pneumothorax. Does anyone have information to share? Thank you.
Pneumothorax is not a contraindication to CPAP usage. However percutaneus aspiration of the pneumothorax or drainage by intercostal chest tube is mandatory for CPAP usage in such patients. CPAP should be deemed to be high risk in untreated pneumothorax .
http://ceaccp.oxfordjournals.org/content/8/6/204.full
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3132366/
In my opinion any pneumothorax under positive pressure (Ventilation) including CPAP in an indication for a chest tube. If the Patient has a chesttube and CPAP is indicated CPAP is allowed.
Agree with the above responses. CPAP should be set to the lowest level necessary to retain alveolar recruitment. If support is needed to maintain gas exchange, the peak pressures of cyclic ventilation are more damaging. The ultimate ventilation strategy for an Intubated patient with pneumothorax is low peak/volume and minimum neceassary PEEP. HFV does this effectively - essentially mimicking and approaching CPAP.
To echo Daniel's comments about HFV, here is a quote from a recent paper:
"Airleak: HFOV may also be considered in patients with a large air leak with inability to
achieve adequate ventilation on CMV. By keeping the lung open, and avoiding cyclical
inflation and deflation, HFOV promotes healing of the lung and sealing of the leak. The
lungs may be able to kept open at lower pressures than with CMV"
Minerva Pediatr. 2015 Apr;67(2):123-40. Epub 2015 Feb 6.
High frequency oscillatory ventilation in children. What do we know so far?
Diaz F1, Kalra Y, Tofil NM, Prabhakaran P.
I can not. I believe there is no credible information pointing into that direction. Airway pressure modification has actually been used to successfully treat pneumothorax in the past, at least in one case. No large-scale follow-up study has ever been published on the matter.
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