From the Guidelines
The patient should not continue using CPAP while they have a pneumothorax with a chest drain in place, as it may worsen the pneumothorax by forcing more air into the pleural space, potentially causing tension pneumothorax or impeding lung re-expansion. This recommendation is based on the guidelines for managing patients with pneumothorax, which suggest that non-invasive ventilation, including CPAP, should be withheld in patients with pneumothorax, independent of its size, as long as the pneumothorax is present 1.
Instead, the patient should receive supplemental oxygen via a non-positive pressure method, such as nasal cannula or simple face mask, to maintain adequate oxygenation while the pneumothorax resolves. The chest drain should be left in place until the pneumothorax has resolved, as confirmed by chest imaging. During this time, the patient's respiratory status should be closely monitored with regular blood gas measurements to assess both oxygenation and CO2 retention.
Some key considerations in managing these patients include:
- Frequent assessment to identify potential complications of respiratory failure, such as worsening hypercapnia or hypoxemia 1
- Careful monitoring of the patient's respiratory status, including regular blood gas measurements
- Consideration of other supportive measures, such as careful positioning, respiratory physiotherapy, or in severe cases, non-invasive ventilation with very careful monitoring once the pneumothorax has significantly improved
- CPAP therapy can be resumed only after complete resolution of the pneumothorax and removal of the chest drain, with a gradual return to their usual settings.
It is essential to prioritize the patient's safety and avoid any interventions that may worsen their condition, such as using positive pressure ventilation in the presence of a pneumothorax. By following these guidelines and closely monitoring the patient's respiratory status, healthcare providers can minimize the risk of complications and improve outcomes for patients with type 2 respiratory failure and pneumothorax.
From the Research
CPAP Use in Patients with Traumatic Pneumothorax
- The use of Continuous Positive Airway Pressure (CPAP) in patients with traumatic pneumothorax requires careful assessment, as it may pose risks 2.
- There is no direct evidence to suggest that a patient with type 2 respiratory failure, who retains carbon dioxide and uses CPAP at home, should continue using CPAP after developing a traumatic pneumothorax with a 10 centimeter pneumothorax and chest tube insertion.
Risks and Benefits of CPAP
- CPAP is a commonly used modality for treating respiratory failure, including type 2 respiratory failure 3.
- However, the use of CPAP may increase the risk of pneumothoraces, particularly in patients with pre-existing lung and thoracic diseases 4, 5.
- In patients with severe disease, helmet-CPAP may be superior to high-flow nasal cannula (HFNC) therapy or facemask non-invasive ventilation (NIV)/CPAP, but with noted important complications 4.
Management of Patients with Pneumothorax
- The management of patients with pneumothorax requires careful consideration of the underlying cause and the patient's individual needs 6.
- In patients with traumatic pneumothorax, the use of CPAP may need to be re-evaluated, and alternative modalities of respiratory support may be considered 4, 6.
- The choice of respiratory support should be contextualized to each setting, taking into account the availability of resources and the patient's individual needs 4.