European Journal of Cardiovascular Medicine

A medical disorder known as spontaneous pneumothorax (SP) causes the pleural cavity to fill with air without any external damage, which in turn causes the collapse of the lungs and respiratory difficulty. Secondary spontaneous pneumothorax (SSP) is linked to pre-existing pulmonary diseases like chronic obstructive pulmonary disease (COPD), tuberculosis, [1-3] or interstitial lung disease; primary spontaneous pneumothorax (PSP) is when no underlying lung disease is present. Every year, there are an estimated 7.4–18 instances of PSP in men and 1.2–6 cases of SSP in females, however the former has a lower incidence but a more severe clinical presentation. When compared to PSP, SSP is more often associated with older age groups, preexisting lung disease, and higher rates of illness and death [2-4].

Different types of spontaneous pneumothorax have different pathophysiologies. Small subpleural blebs or bullae rupture is thought to cause PSP in tall, slender young men, whereas chronic disease processes weaken the lungs and cause SSP. Severity of symptoms, which can be correlated with the extent of the pneumothorax and the presence of underlying pulmonary diseases, can be observed in cases of spontaneous pneumothorax [3-5]. These symptoms include acute-onset dyspnea, pleuritic chest pain, tachypnea, tachycardia, and hypoxia. Clinical symptoms and imaging findings work together to make a diagnosis; a chest X-ray is the gold standard for initial diagnosis, with computed tomography (CT) providing a more in-depth evaluation for complicated or recurring cases [4-6].

For patients experiencing symptoms, tube thoracostomy is still the preferred method of treating moderate to large pneumothorax. In order to restore normal respiratory function and allow for lung re-expansion, this operation entails inserting a chest tube into the pleural cavity to drain air. Although it is a commonly used and successful technique, there has been limited research on how it affects clinical parameters such as blood pressure, pH, arterial blood gas values, respiratory rate, oxygen saturation, and heart rate. These metrics are useful for predicting the patient's prognosis for recovery or problems since they reveal important information about their metabolic and respiratory status [5-7].

While it has been found that tube thoracostomy improves ventilation and oxygenation, the extent to which these physiological changes occur and when they occur have not been well investigated. Furthermore, patient outcomes can be affected by complications such as infection, subcutaneous emphysema, re-expansion pulmonary edema, chronic air leakage, and so on. Refining post-procedural monitoring techniques and optimizing patient management strategies can be achieved by understanding the effects of tube thoracostomy on these parameters [6-8].

The purpose of this research is to compare the levels of arterial blood gas and clinical variables in individuals who developed spontaneous pneumothorax before and after tube thoracostomy. Our goal is to help clinicians make better decisions and improve patient outcomes while managing pneumothorax by analyzing the physiological response to tube thoracostomy at predetermined time intervals after the procedure [7-9].

50 patients from a tertiary care hospital who needed a tube thoracostomy due to spontaneous pneumothorax were part of a prospective observational study that ran from January 2018 to December 2018 at Department of Pulmonary Medicine, Viswabharathi Medical College, Penchikalapadu, Kurnool, Andhra Pradesh, India. The study was limited to individuals who were 18 years old or older, had a radiological confirmation of SP, and had a reason to undergo tube thoracostomy. Exclusion criteria included a history of serious cardiovascular illness, pneumothorax (both tension and traumatic), or a patient's current state of extreme stress. Prior to and within 6-12 hours after the procedure, baseline clinical parameters such as heart rate, respiratory rate, oxygen saturation, blood pressure, and acid base balance values (pH, PaO2, PaCO2, HCO3-) were assessed. Data was analyzed using SPSS Version 22, with paired t-tests or Wilcoxon signed-rank tests utilized as needed.

Inclusion Criteria:

• Patients aged ≥18 years with a confirmed diagnosis of spontaneous pneumothorax
• Patients requiring tube thoracostomy as part of their treatment protocol.
• Hemodynamically stable patients without immediate life-threatening complications.
• Patients who provided informed consent to participate in the study.

Exclusion Criteria:

• Patients with tension pneumothorax requiring emergency needle decompression
• Patients with traumatic pneumothorax due to blunt or penetrating chest injury.
• Patients with recurrent pneumothorax previously treated with surgical pleurodesis

The study comprised 50 individuals with a mean age of 35.6 ± 10.2 years who had spontaneous pneumothorax (SP) diagnosed. There were four times as many men as women, suggesting that men were more common. Pleuritic chest discomfort (75% of cases) and dyspnea (90%) were the most prevalent first symptoms.

Table 1: Baseline Characteristics of the Study Population

After a tube thoracostomy, clinical measures showed a marked improvement. In a statistically significant manner, the respiratory rate (RR) dropped from 28.4 ± 4.5 breaths/min to 18.2 ± 3.1 breaths/min. There was a significant improvement in oxygen saturation (SpO₂) from 86.5 ± 5.4% to 97.2 ± 2.3% (p < 0.001), and a drop in heart rate (HR) from 110.3 ± 12.7 bpm to 89.6 ± 10.5 bpm (p = 0.002).

Table 2: Changes in Clinical Parameters before and After Tube Thoracostomy

The results showed that gas exchange and ventilation were better after the surgery, as the PaO₂ levels increased from 62.4 ± 9.1 mmHg to 85.7 ± 8.3 mmHg (p < 0.001) and the PaCO₂ levels reduced from 52.1 ± 7.5 mmHg to 41.8 ± 6.2 mmHg (p = 0.005). The pH values improved somewhat, but significantly, from 7.31 ± 0.04 to 7.38 ± 0.03 (p = 0.03), whereas the levels of HCO₃⁛ stayed quite consistent.

Table 3: Changes in arterial blood gas parameters before and after tube thoracostomy

Twenty percent of patients experienced complications, including re-expansion pulmonary edema (4%), moderate subcutaneous emphysema (6%), and chronic air leak (10%). No serious side effects were recorded, and all issues were handled cautiously.

Table 4: Post-Thoracostomy Complications

Overall, tube thoracostomy resulted in a significant improvement in respiratory function as well as arterial blood gas values, which made it possible for the majority of patients to experience symptomatic relief.

This study's results offer credence to the idea that individuals suffering from spontaneous pneumothorax can greatly benefit from tube thoracostomy in terms of respiratory performance and arterial blood gas measurements. This intervention successfully alleviated respiratory distress, resulting to greater oxygenation and ventilation efficiency, as seen by the considerable reduction in respiratory rate and improvement in oxygen saturation [10-12]. The clear correlation between the rise in PaO₂ levels and the fall in PaCO₂ values provides more evidence that tube thoracostomy improves pulmonary gas exchange, an essential factor in stabilizing patients with impaired lung function. The rapid benefits of the operation in reversing hypoxia and respiratory acidosis are highlighted by these changes, which improve patient outcomes [13-15].

Our findings that men are more likely than females to experience spontaneous pneumothorax are in line with earlier epidemiological data that point to a mix of skeletal and behavioral variables explaining why men experience this condition at a higher rate [16-18]. Sixty percent of our patients smoked, which is associated with an increased risk of primary and secondary spontaneous pneumothorax. Pneumothorax is more likely to occur when blebs form and then rupture, which can be caused by smoking-induced inflammation of the airways and damage to the alveoli [19-21].

Although problems are uncommon, they do highlight the need for vigilant post-procedure monitoring. As a well-documented difficulty following tube thoracostomy, persistent air leak—the most common complication—often necessitates extended chest tube drainage. Although less prevalent, subcutaneous emphysema and re-expansion pulmonary edema show that even little procedural problems require careful management to guarantee good patient outcomes [22-24]. Tube thoracostomy is the gold standard for treating spontaneous pneumothorax, according to this study, since it significantly improves both clinical and physiological outcomes. Optimizing patient treatment and recovery should be the goal of future research into post-thoracostomy monitoring measures, specifically the identification of early signs for problems [25-27].

Results show that tube thoracostomy is a successful intervention for spontaneous pneumothorax, improving respiratory function and arterial blood gas values significantly. Its function in alleviating respiratory distress and improving gas exchange is confirmed by the significant decrease in respiratory rate, improvement in oxygen saturation, and normalization of PaO₂ and PaCO₂ values. Our findings, which confirm previous epidemiological research on the causes and risk factors of spontaneous pneumothorax, are supported by the fact that our sample is predominantly male and that smoking is highly prevalent. Conservative treatment was usually effective in managing problems such as re-expansion pulmonary edema, subcutaneous emphysema, and chronic air leak. These results highlight the significance of patient education, meticulous post-procedure monitoring, and early intervention in enhancing clinical outcomes. Improving patient recovery while minimizing side effects should be the goal of future research into post-thoracostomy care optimization, early complication prediction, and management strategy refinement.

Funding: 

None

Conflict of Interest:

None

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