[Spontaneous and iatrogenic pneumothorax in the adult. 217 personal cases]

This study is dedicated to the epidemiology of pneumothoraces (217 cases) during the last 8 years in an Intensive Care Department where most patients were admitted for respiratory diseases. Cases resulting from road-injury or surgery were excluded. Spontaneous pneumothoraces accounted for 61.8% of the cases. Among them, the most current etiology was idiopathic pneumothorax owing to small subpleural blebs, rarely leading to tension pneumothorax or hemapneumothorax. Other causes were pulmonary emphysema, more often than chronic obstructive pulmonary disease or acute asthma, active pulmonary tuberculosis, and acute pneumonia (especially AIDS-related Pneumocystis Carinii pneumonia). Among the iatrogenic pneumothoraces (38.2%), three sources accounted for 79 out of the 83 cases observed: drainage of pleural effusions, subclavian vein catheterization, mechanical ventilation of patients suffering from refractory hypoxemia or evincing very high bronchial resistances, therefore requiring special ventilatory techniques, such as positive end-expiratory pressure. Whereas pneumothoraces induced by pleural or venous access were not by themselves detrimental, the course of pneumothorax associated with ventilatory support was as a rule unfavourable, death being due to the pneumothorax per se in about fifty per cent of the cases. Various techniques, unequally efficient, were suggested to avoid or control this ominous side-effect of mechanical ventilation, which remains a serious problem.