From the Guidelines
No, the patient should not continue using their CPAP while they have a pneumothorax with a chest drain in place. CPAP delivers positive pressure to the airways, which could worsen the pneumothorax by forcing more air into the pleural space, potentially causing tension pneumothorax or impeding lung re-expansion 1. The chest drain needs to function with negative pleural pressure to evacuate the air and allow the lung to re-expand.
Instead, the patient should receive supplemental oxygen via a non-positive pressure method (such as nasal cannula or Venturi mask) titrated carefully to maintain oxygen saturation while avoiding excessive oxygen that could suppress respiratory drive in this CO2 retainer. Key considerations in managing the patient's oxygen therapy include:
- Careful titration of oxygen to maintain adequate saturation without suppressing respiratory drive
- Close monitoring of the patient's respiratory status
- Avoidance of positive pressure ventilation unless absolutely necessary and under close supervision
Once the pneumothorax has fully resolved, the chest drain has been removed, and follow-up imaging confirms complete lung re-expansion, CPAP therapy can be gradually reintroduced under close monitoring 1. During this period, the patient's type 2 respiratory failure should be managed with careful oxygen therapy, positioning, and possibly non-invasive ventilation only if absolutely necessary and under extremely close supervision. It is essential to weigh the risks and benefits of continuing CPAP therapy in the context of a pneumothorax, prioritizing the patient's safety and avoiding potential complications such as tension pneumothorax or impeded lung re-expansion.
From the Research
Patient Considerations
- The patient has type 2 respiratory failure, retains carbon dioxide, and uses Continuous Positive Airway Pressure (CPAP) at home with 1 liter of home oxygen.
- The patient has developed a traumatic pneumothorax with a 10 centimeter pneumothorax and chest tube insertion.
CPAP Use in Hospitals
- According to 2, patients may want to use their own ventilators or CPAP units when admitted to the hospital, but this presents many risks.
- The study recommends against allowing patients to use their own ventilators or CPAP units in the hospital, except in justified circumstances with a case-by-case assessment.
Non-Invasive Ventilation
- 3 discusses new modalities for non-invasive positive pressure ventilation, including CPAP and BiPAP, which are commonly used to treat respiratory failure.
- 4 explains that non-invasive ventilation refers to the delivery of mechanical ventilation to the lungs without an endotracheal airway, with CPAP and pressure support ventilation being two modalities.
CPAP and Pneumothorax
- 5 reports a case of a large pneumothorax in a sleep apnea patient with CPAP without previously known lung and thoracic diseases.
- The study suggests that alveolar inflammatory changes due to over-distention and increased pressure in the alveoli can occur after years of CPAP treatment, leading to spontaneous pneumothorax.
Perioperative Non-Invasive Respiratory Support
- 6 reviews the use of non-invasive respiratory support, including CPAP, in the perioperative period, highlighting its potential roles and risks.
- The study notes that non-invasive ventilation has been associated with improved ventilatory variables and reduced risk of postoperative respiratory complications, but also carries risks such as upper airway obstruction and worsening hypoventilation.
Considerations for Continuing CPAP
- Given the patient's traumatic pneumothorax and chest tube insertion, it is essential to weigh the benefits and risks of continuing CPAP therapy, as discussed in 2 and 5.
- The patient's type 2 respiratory failure and carbon dioxide retention should also be considered when deciding whether to continue CPAP, as non-invasive ventilation can be beneficial in treating respiratory failure, as noted in 3 and 4.