Iatrogenic pneumothorax: etiology, incidence and risk factors

We discuss the etiology and incidence of iatrogenic pneumothorax (IPnx) which can develop after invasive procedures performed for diagnostic and/or therapeutic purposes, and the efforts to prevent this complication and its consequences.

The records of patients who were treated for the diagnosis of IPnx between December 1998 and December 2006 were retrospectively reviewed. The patients were evaluated according to their age, gender, the procedure which caused IPnx, the department which performed the procedure, the treatment and its consequences.

12 010 invasive procedures were performed in our hospital during the period and 164 patients (1.36 %) developed IPnx. Their mean age was 49.27 (range: 8 months-93 years). Of the patients, 101 (61 %) were male and 63 (39 %) were female. The 56.7 % of the invasive procedures which caused IPnx were performed under emergency conditions and 43.3 % were performed under elective conditions. In 69 patients (42 %) the procedures were performed due to underlying lung diseases and in 95 patients (58 %) for diseases other than lung diseases. The most frequent procedure type causing IPnx was central venous catheterization, with 72 patients (43.8 %). The other frequent causes were thoracentesis with 33 patients (20.1 %) and barotrauma due to mechanical ventilation with 15 patients (9.1 %).

At training hospitals the incidence of IPnx will increase in parallel to the increase in invasive procedures. Invasive procedures should be performed by experienced personnel or under their supervision when risk factors are involved.