Iatrogenic pneumothorax: experience of a Moroccan Emergency Center

array:24 ["pii" => "S2173511513000213" "issn" => "21735115" "doi" => "10.1016/j.rppnen.2013.03.002" "estado" => "S300" "fechaPublicacion" => "2013-03-01" "aid" => "122" "copyright" => "Sociedade Portuguesa de Pneumologia" "copyrightAnyo" => "2012" "documento" => "article" "crossmark" => 0 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "fla" "cita" => "Rev Port Pneumol. 2013;19:65-9" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 3431 "formatos" => array:3 [ "EPUB" => 247 "HTML" => 2213 "PDF" => 971 ] ] "itemSiguiente" => array:19 [ "pii" => "S2173511513000171" "issn" => "21735115" "doi" => "10.1016/j.rppnen.2013.02.006" "estado" => "S300" "fechaPublicacion" => "2013-03-01" "aid" => "119" "copyright" => "Sociedade Portuguesa de Pneumologia" "documento" => "article" "crossmark" => 0 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "fla" "cita" => "Rev Port Pneumol. 2013;19:70-5" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 5358 "formatos" => array:3 [ "EPUB" => 232 "HTML" => 3714 "PDF" => 1412 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "Original article" "titulo" => "Evaluation of the oxidant and antioxidant balance in the pathogenesis of chronic obstructive pulmonary disease" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "pt" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "70" "paginaFinal" => "75" ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Avaliação do equilíbrio entre oxidantes e antioxidantes na patogénese da doença pulmonar obstrutiva crónica" ] ] "contieneResumen" => array:2 [ "en" => true "pt" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 818 "Ancho" => 1382 "Tamanyo" => 60403 ] ] "descripcion" => array:1 [ "en" => "Levels of malondialdehyde (MDA) in plasma from control subjects and COPD patients. Values are expressed as mean±SEM. p<0.001 significantly different between controls and whole COPD group. p<0.01 significantly different between controls and non-smoker patients. p<0.001 significantly different between controls and ex-smoker patients. There was no significant differences between non-smokers and ex-smokers COPD patients." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "C. Cristóvão, L. Cristóvão, F. Nogueira, M. Bicho" "autores" => array:4 [ 0 => array:2 [ "nombre" => "C." "apellidos" => "Cristóvão" ] 1 => array:2 [ "nombre" => "L." "apellidos" => "Cristóvão" ] 2 => array:2 [ "nombre" => "F." "apellidos" => "Nogueira" ] 3 => array:2 [ "nombre" => "M." "apellidos" => "Bicho" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173511513000171?idApp=UINPBA00004E" "url" => "/21735115/0000001900000002/v1_201305151603/S2173511513000171/v1_201305151603/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2173511513000201" "issn" => "21735115" "doi" => "10.1016/j.rppnen.2013.03.001" "estado" => "S300" "fechaPublicacion" => "2013-03-01" "aid" => "130" "copyright" => "Sociedade Portuguesa de Pneumologia" "documento" => "article" "crossmark" => 0 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "fla" "cita" => "Rev Port Pneumol. 2013;19:59-64" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 3915 "formatos" => array:3 [ "EPUB" => 248 "HTML" => 2635 "PDF" => 1032 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "Original article" "titulo" => "Surgical lung biopsy for diffuse lung disease. Our experience in the last 15 years" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "pt" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "59" "paginaFinal" => "64" ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Biópsia pulmonar cirúrgica na doença pulmonar difusa. A nossa experiência nos últimos 15 anos" ] ] "contieneResumen" => array:2 [ "en" => true "pt" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1614 "Ancho" => 2139 "Tamanyo" => 99276 ] ] "descripcion" => array:1 [ "en" => "Distribution of the number of lung biopsies performed between 1997 and 2011. Notice how from the year 2004 (arrow) there is a decreased in the number of biopsies performed." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "M. Blanco, G.A. Obeso, J.C. Durán, J.E. Rivo, E. García-Fontán, E. Peña, M. Rodríguez, J. Albort, M.A. Cañizares" "autores" => array:9 [ 0 => array:2 [ "nombre" => "M." "apellidos" => "Blanco" ] 1 => array:2 [ "nombre" => "G.A." "apellidos" => "Obeso" ] 2 => array:2 [ "nombre" => "J.C." "apellidos" => "Durán" ] 3 => array:2 [ "nombre" => "J.E." "apellidos" => "Rivo" ] 4 => array:2 [ "nombre" => "E." "apellidos" => "García-Fontán" ] 5 => array:2 [ "nombre" => "E." "apellidos" => "Peña" ] 6 => array:2 [ "nombre" => "M." "apellidos" => "Rodríguez" ] 7 => array:2 [ "nombre" => "J." "apellidos" => "Albort" ] 8 => array:2 [ "nombre" => "M.A." "apellidos" => "Cañizares" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173511513000201?idApp=UINPBA00004E" "url" => "/21735115/0000001900000002/v1_201305151603/S2173511513000201/v1_201305151603/en/main.assets" ] "en" => array:19 [ "idiomaDefecto" => true "cabecera" => "Original" "titulo" => "Iatrogenic pneumothorax: experience of a Moroccan Emergency Center" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "65" "paginaFinal" => "69" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "M.M. El Hammoumi, G. Drissi, A. Achir, A. Benchekroun, A. Benosman" "autores" => array:5 [ 0 => array:4 [ "nombre" => "M.M." "apellidos" => "El Hammoumi" "email" => array:1 [ 0 => "hamoumimassine@hotmail.fr" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "¿" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "G." "apellidos" => "Drissi" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "A." "apellidos" => "Achir" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "A." "apellidos" => "Benchekroun" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 4 => array:3 [ "nombre" => "A." "apellidos" => "Benosman" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Department of thoracic surgery, hospital Avicenne, Rabat, Morocco" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Department of Surgical emergencies, Hospital Avicenne, Rabat, Morocco" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Pneumotórax Iatrogénico: experiência de um Centro de Emergência Marroquino" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:6 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 897 "Ancho" => 900 "Tamanyo" => 123549 ] ] ] ] "textoCompleto" => "Introduction:Pneumothorax is a serious but common complication of invasive chest procedures. Several procedures were identified as causing pneumothorax, but according to the literature the most frequent causes are thoracocentesis,central venous cannulation and barotraumas.In the present climate of increased use of invasive procedures, the incidence of iatrogenic pneumothorax (IPx) is going to increase particularly in training hospitals. It is for this reason that we want assess and delineate retrospectively the common diagnostic or therapeutic causes of IPx and its impact on morbidity.Materials and methods:From January 2011 to December 2012, we listed 36 cases of patients who developed IPx in the emergency department, after an invasive procedure for diagnostic or therapeutic purposes. For each patient was details of age, gender, the invasive procedure which caused IPnx, the specific treatment and consequences were recorded.Results:The mean age was 38 years (range: 19-69 years). Twenty one (58%) of the patients were male and 15 (42%) were female. All the invasive procedures which caused IPnx were performed under as emergencies in the Emergency Department. The purpose of the invasive procedure was diagnostic in 6 cases and therapeutic in 30 cases.8 patients (22%) had procedures for underlying lung or tracheal diseases and 28 patients (78%) for other diseases. (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>)<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>The procedure type most frequently causing IPnx was subclavian and jugular central venous catheterization; 20 patients (55%) (right side; n=15,left side; n=5). The other frequent causes were barotraumatism due to mechanical ventilation (<a class="elsevierStyleCrossRef" href="#fig0005">figure 1</a>); 8 cases (22%). Of this 8 there were 3 cases with bilateral pneumothorax, 6 cases of thoracentesis (16%) and in 2 patients had life-saving percutaneous tracheotomy. (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>)<elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia>Clinical signs compatible with a pneumothorax were found in all patients with associated radiographic signs.Percutaneous tracheotomies were performed by the physician (not a surgeon) who admitted the patient and indicated a life saving tracheotomy in the intensive care unit.According to our protocol, once the invasive procedure is accomplished a systematic chest radiograph is taken.Regardless of the causal procedure, and depending on patient stability and the size of the pneumothorax the majority (n=33, 91,6%) of our patients were managed by a small chest tube placement (unilateral n=30, bilateral n=3).The chest tube placement was performed by a trained physician, using either the ventral approach (2.-3. Intercostals space) in the mid-clavicular line: also called the approach according to Monaldi (n=8, chest tube Joly size 16), or the lateral approach (4.-6. intercostal space) in the anterior to mid-axillary line also called the approach according to Bulau(n=28, chest tube Joly size16-18) The tube is connected to a bottle or canister. Suction is often used to help it drain. Otherwise, gravity alone will allow it to drain.Once the drain was in place, a chest radiograph was taken to check the location of the drain. The tube stayed in for as long as there was air or fluid to be removed, or the risk of air gathering.Clinical malfunction of the tube with a radiological malposition was noted in 6 cases with a chest tube replacement by a larger size chest tube (Joly size 18). Malfunction was due to the interlobar placement of the tube.The average of duration of drainage was 3 days (range: 1-15days), sadly one of our patients died of ischemic brain damage 15 days after percutaneous tracheotomy.Hospitalization was prolonged due to this treatment in only 10 cases, presumably because of the underlying disease which required long hospitalization.Discussion:To the best of our knowledge Iatrogenous Pneumothorax has very rarely been reported in the English literature, we entered “pneumothorax” AND “Iatrogenous” in Pubmed and there were no retrospective or prospective studies about the incidence of this complication which is one of the most common complications of invasive chest procedures. The morbidity associated with pneumothorax, particularly with a chest tube placement, should be a warning to physicians to avoid all unnecessary pneumothorax-related procedures especially in emergencies.Careful choice of the site for percutaneous central vascular access is recommended, the internal jugular vein is preferable because of the lower frequency of related pneumothorax, 7 IPx of 424 subclavian puncture site in the study of Pikwer<a class="elsevierStyleCrossRef" href="#bib0005">1</a>, and 4 IPx of 1552jugular puncture in the same study . Eisen and al.<a class="elsevierStyleCrossRef" href="#bib0010">2</a> obtained similar results and concluded that a higher risk of pneumothorax was associated with the subclavian puncture, in our study 12 of the 20 patients had a subclavian approach, which is explained by anatomical proximity of sub clavian vessels to the pleural space and the greater familiarity of physicians with this site but Shummer and .Al<a class="elsevierStyleCrossRef" href="#bib0015">3</a> noted in a prospective study of 1794 catheterizations similar risk of IPx in subclavian and internal jugular site.Thoracocentesis in order to evacuate recurrent or large pleural effusions is traditionally a safe procedure when performed by an experienced operator. IPx occurred in 19% in the study of Grogan and Al<a class="elsevierStyleCrossRef" href="#bib0020">4</a>, and 5,1% in the recent study of Henry and Al<a class="elsevierStyleCrossRef" href="#bib0025">5</a>. However the latter found no statistically significant association between the occurrence of pneumothorax and the type of needle used, the size of the effusion, the amount of fluid drained, the presence of loculations, the type of thoracentesis, or the experience of the operator. All our thoracocentesis-related pneumothorax were performed by training operators so we conclude that thoracocentesis can be difficult and needs a controlled setting.In our study, we did not use ultrasound control after six thoracocentesis but a chest radiograph control .However, several studies have demonstrated high sensitivity and specificity for thoracic ultrasound in detecting of occult pneumothorax in critical care,<a class="elsevierStyleCrossRef" href="#bib0030">6</a> and trauma patients.<a class="elsevierStyleCrossRef" href="#bib0035">7</a> The absence of lung sliding suggests pneumothorax, but it can occur in manyultiple other conditions such as mainstem intubation, acute respiratory distress syndrome, or pleural adhesions. The “lung point” is an ultrasound sign with 100% specificity for pneumothorax,<a class="elsevierStyleCrossRef" href="#bib0040">8</a> and can be used to determine the size of the pneumothorax.<a class="elsevierStyleCrossRef" href="#bib0045">9</a>Very few studies have been published about the role of tracheotomy in the pathogenesis of pneumothorax. Glicklick and All <a class="elsevierStyleCrossRef" href="#bib0050">10</a> reported 17% IPx in his earlier study of 45 tracheotomies. Pneumothorax is more significantly possible when tracheotomy is an emergency <a class="elsevierStyleCrossRef" href="#bib0055">11</a>. Some authors<a class="elsevierStyleCrossRef" href="#bib0055">11</a> proved experimentally the mechanism of pneumothorax via a pneumomediastinum secondary to air way hyper pressure during tracheotomy and surgery.Complications with mechanical ventilation are common, and rupture of the pulmonary alveoli or airways after a sudden increase of intra-alveolar pressure is a common cause of pneumothorax. The incidence of pneumothorax during ARDS is less than 10% since the reduction of tidal volume and limiting plateau pressure. The more aggressive use of ventilator pressure characteristics was found to be associated with a higher incidence of pneumothorax, 17% in the study of Miller<a class="elsevierStyleCrossRef" href="#bib0060">12</a> who noted the major role of protective lung strategy. In our study, the 8 cases with barotraumatisms had an associated Acute Respiratory Distress Syndrome and lung obstructive disease which increased the side effects of mechanical ventilation. An existing lung disease such as Chronic Obstructive Pulmonary Disease (COPD), or asthma is the most common cause of a greater associated incidence of pneumothorax after positive pressure ventilation.<a class="elsevierStyleCrossRef" href="#bib0065">13</a> These patients have generally bleb or bulla due to airway obstruction. Acute respiratory distress syndrome (ARDS) is defined by bilateral pulmonary infiltrates with a decreased lung compliance responsible for high alveolar pressure even using low tidal volume. Chest X-ray or Computed Tomography is used to detect the air leak: pneumothorax or pneumomediastinum with possible risk of heamodynamic complications. Risk factors associated with barotrauma are the underlying disease for mechanical ventilation and a high airway pressure during mechanical ventilation<a class="elsevierStyleCrossRef" href="#bib0070">14</a>. Alveolar pressure, obtained by measuring plateau pressure at the end of the inspiration, is the best tool for evaluating the risk of alveolar barotrauma. This pressure must be kept below 30cmH2O.<a class="elsevierStyleCrossRef" href="#bib0070">14</a>Barotraumatic pneumothorax was managed by chest tube placement to prevent tension pneumothorax and heamodynamic complication s and in our cases the time the chest tube was in place was longer (4 days).We use a preventive protocol in mechanic ventilation to avoid alveolar hyperpressure depending on the underlying lung disease and severity of the ARDS: a controlled low tidal volume ventilation is taken.It is commonly believed that the size of a pneumothorax is an important determinant of treatment decision particularly as to whether chest tube drainage is required. In our practice we still use clinical and chest radiological data to take a decision, however, a volumetric quantification of pneumothoraces has been performed in a Chinese study <a class="elsevierStyleCrossRef" href="#bib0075">15</a> by automated computer-aided volumetry in CT images. The results indicated that the inclusion of volume made it the most statistically significant indicators compared to the other tests in which volume was excluded from the clinical parameters<a class="elsevierStyleCrossRef" href="#bib0075">15</a>. This study provides the evidence for the application of volumetric quantification of pneumothoraces in the management of clinically stable chest trauma patients with traumatic pneumothorax but it is based on computed tomography images which are not a systematic part of our practice.Most authors recommend the lateral approach for chest tube insertion.<a class="elsevierStyleCrossRefs" href="#bib0080">16,17</a> without data documenting why they advise against using the ventral approach. To the best of our knowledge there are no studies which just examine the ventral approach or investigate differences between the two common approaches. Some authors recommend that if an approach other than the lateral is chosen then it should be performed by a thoracic surgeon<a class="elsevierStyleCrossRefs" href="#bib0090">18,19</a>.The ATLS manual recommends that the chest tube should “usually” be inserted via the lateral approach.<a class="elsevierStyleCrossRef" href="#bib0090">18</a> .In our protocol, to avoid the potential risk of lacerating the internal mammary artery and to have a safer intercostals space for preparation we use the lateral approach which is frequently described as a “safe zone”. We reserve the ventral approach for anterior pneumothoraces.ConclusionThis review summarizes the current state of etiologies of IPx. Another factor is that we had many attending physicians on-scene. The influence of differing individual skills and different levels of familiarity with invasive procedures can affect the incidence of iatrogenous complications. So it is advisable to use ultrasound guidance whenever possible for central venous cannulation or thorcocentesis. If pneumothorax occurs, it is important to recognize the signs and symptoms particularly during mechanical ventilation or with underlying lung disease. A chest X-ray should be promptly done. Depending on its size and symptoms, treatment can vary from simple observation to a chest tube placement to be performed by experienced personnel or under their supervision even at training hospitals.Ethic disclosuresProtection of human and animal subjectsThe authors declare that no experiments were performed on humans or animals for this investigation.Confidentiality of DataThe authors declare that no patient data appears in this article.Right to privacy and informed consentThe authors declare that no patient data appears in this article.Conflicts of interestThe authors have no conflicts of interest to declare." "textoCompletoSecciones" => array:1 [ "secciones" => array:12 [ 0 => array:2 [ "identificador" => "xres175798" "titulo" => "Abstract" ] 1 => array:2 [ "identificador" => "xpalclavsec164131" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xres175797" "titulo" => "Resumo" ] 3 => array:2 [ "identificador" => "xpalclavsec164132" "titulo" => "Palavras chave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction:" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Materials and methods:" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Results:" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion:" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Conclusion" ] 9 => array:3 [ "identificador" => "sec0030" "titulo" => "Ethic disclosures" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0035" "titulo" => "Protection of human and animal subjects" ] 1 => array:2 [ "identificador" => "sec0040" "titulo" => "Confidentiality of Data" ] 2 => array:2 [ "identificador" => "sec0045" "titulo" => "Right to privacy and informed consent" ] ] ] 10 => array:2 [ "identificador" => "sec0050" "titulo" => "Conflicts of interest" ] 11 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2012-07-24" "fechaAceptado" => "2012-11-08" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec164131" "palabras" => array:3 [ 0 => "Pneumothorax" 1 => "Iatrogenic" 2 => "Drainage" ] ] ] "pt" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palavras chave" "identificador" => "xpalclavsec164132" "palabras" => array:3 [ 0 => "Pneumotórax" 1 => "Iatrogénico" 2 => "Drenagem" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "The incidence of iatrogenic pneumothorax (IPx) will increase with invasive procedures particularly at training hospitals, which is why we have made a retrospective study of the common diagnostic or therapeutic causes of IPx and its impact on morbidity. From January 2011 to December 2012, 36 patients developed IPx as emergencies, after an invasive procedure .Their mean age was 38 years (range: 19-69 years). Of the patients, 21 (58%) were male and 15 (42%) were female. The purpose was diagnostic in 6 cases and therapeutic in 30 cases. In 8 patients (22%) the procedure was performed due to underlying lung diseases and in 28 patients (78%) for other diseases. The procedure most frequently causing IPnx was central venous catheterization, with 20 patients (55%), other frequent causes were mechanical ventilation, 8 cases (22%) of whom we reported 3 cases of bilateral pneumothorax, 6 cases of thoracentesis (16%) and 2 patients had life-saving percutaneous tracheotomy. The majority of our patients were managed by a small chest tube placement (unilateral n=30, bilateral n=3).The average duration of drainage was 3 days (range: 1-15 days), sadly one of our patients died of ischemic brain damage 15 days after tracheotomy.At training hospitals the incidence of IPnx will increase with the increase in invasive procedures, which should only be performed by experienced personnel or under their supervision." ] "pt" => array:2 [ "titulo" => "Resumo" "resumen" => "A incidência de pneumotórax iatrogénico (IPx) vai aumentar com procedimentos invasivos particularmente em hospitais de formação, sendo esse o motivo pelo qual fizemos um estudo retrospetivo do diagnóstico ou das causas terapêuticas comuns de IPx e do seu impacto na morbidade. Desde janeiro de 2011 até dezembro de 2012, 36 pacientes desenvolveram IPx como emergências, depois de um procedimento invasivo. A sua média de idades foi de 38 anos (intervalo: 19-69 anos). Dos pacientes, 21 (58%) eram do sexo masculino e 15 (42%) do sexo feminino. O objetivo era diagnóstico em 6 casos e terapêutico em 30 casos. Em 8 pacientes (22%) do procedimento foi realizado devido a doenças pulmonares subjacentes e em 28 pacientes (78%) por outras doenças. O procedimento que mais frequentemente provocou IPnx foi cateterização venosa central, com 20 doentes (55%), outras causas frequentes foram a ventilação mecânica, 8 casos (22%) dos quais foram relatados 3 casos de pneumotórax bilateral, 6 casos de toracocentese (16%) e 2 pacientes traqueotomia percutânea de socorro. A maioria dos nossos pacientes foram administrados pela colocação de um pequeno dreno de tórax (unilateral n=30, bilateral n=3). A duração média da drenagem foi de 3 dias (intervalo: 1-15 dias), tendo infelizmente um dos nossos pacientes falecido devido a dano cerebral isquémico, 15 dias após a traqueotomia.Em hospitais de formação a incidência de IPnx aumentará com o cada vez maior número de procedimentos invasivos, que apenas devem ser desempenhados por pessoal experiente ou sob a supervisão do mesmo." ] ] "multimedia" => array:3 [ 0 => array:6 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 897 "Ancho" => 900 "Tamanyo" => 123549 ] ] ] 1 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Number of Invasive procedure for Diagnostic purpose \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Number of Invasive procedure for Therapeutic Purpose \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Spontaneous Pleural effusion (HVC-hepatic cirrhosis) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Thoracocentesis: 6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Trauma without pleural effusion \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Venous central catheter: 17 Mechanical ventilation: 3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Respiratory failure (lung disease, BPCO, asthm) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Mechanical ventilation: 5 Venous central catheter: 3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Facial trauma \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Tracheotomy: 2 Mechanical ventilation: 2 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab268177.png" ] ] ] ] "descripcion" => array:1 [ "en" => "diseases associated with the iatrogenous pneumthorax." ] ] 2 => array:7 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Cause of IPx \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="2" align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">n (number of cases)</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Right IPx \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Left IPx \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Bilateral IPx \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Central venous catheterization \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="2" align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">20</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Subclavian puncture: 12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Jugular puncture: 8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Barotraumatism \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Thoracentesis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Percutaneous tracheotomy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab268176.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Invasive procedures associated with iatrogenous pneumothorax." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:19 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Routine chest X-ray is not required after a low-risk central venous cannulation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "A. Pikwer" 1 => "I. Perstoft" 2 => "B. Davidson" 3 => "J. Keson" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1399-6576.2009.01980.x" "Revista" => array:6 [ "tituloSerie" => "Acta Anaesthesiol Scand" "fecha" => "2009" "volumen" => "53" "paginaInicial" => "1145" "paginaFinal" => "1152" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19422354" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Mechanical complications of central venous catheters" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "L.A. Eisen" 1 => "M. Narasimhan" 2 => "J.S. Berger" 3 => "P.H. Mayo" 4 => "M.J. Rosen" 5 => "R.F. Schneider" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1177/0885066605280884" "Revista" => array:7 [ "tituloSerie" => "J Intensive Care Med" "fecha" => "2006" "volumen" => "21" "paginaInicial" => "40" "paginaFinal" => "46" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16698743" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0016508509011640" "estado" => "S300" "issn" => "00165085" ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Mechanical complications and malpositions of central venous cannulations by experienced operators. A prospective study of 1794 catheterizations in critically ill patients" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "SchummerW" 1 => "C. Schummer" 2 => "N. Rose" 3 => "W.D. Niesen" 4 => "S.G. Sakka" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00134-007-0560-z" "Revista" => array:7 [ "tituloSerie" => "Intensive Care Med" "fecha" => "2007" "volumen" => "33" "paginaInicial" => "1055" "paginaFinal" => "1059" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17342519" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S1470204509702062" "estado" => "S300" "issn" => "14702045" ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Complications associated with thoracentesis: a prospective randomized study comparing three different methods" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "D.R. Grogan" 1 => "R.S. Irwin" 2 => "R. Channick" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:7 [ "tituloSerie" => "Arch Intern Med" "fecha" => "1990" "volumen" => "150" "paginaInicial" => "873" "paginaFinal" => "877" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2183735" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0959804909001245" "estado" => "S300" "issn" => "09598049" ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Colt, Nancy Brewer and Edward Barbur" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "G. Henri" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Evaluation of Patient-Related and Procedure-Related Factors Contributing to Pneumothorax Following Thoracentesis Chest" "fecha" => "1999" "volumen" => "116" "paginaInicial" => "134" "paginaFinal" => "138" ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ultrasound diagnosis of occult pneumothorax" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "D.A. Lichtenstein" 1 => "G. Mezière" 2 => "N. Lascola" 3 => "P. Biderman" 4 => "J.P. Courret" 5 => "A. Gepner" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Crit Care Med" "fecha" => "2005" "volumen" => "33" "paginaInicial" => "1231" "paginaFinal" => "1238" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15942336" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A prospective comparison of supine chest radiography and bedside ultrasound for the diagnosis of traumatic pneumothorax" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "M. Blaivas" 1 => "M. Lyon" 2 => "S. Duggal" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1197/j.aem.2005.05.005" "Revista" => array:6 [ "tituloSerie" => "Acad Emerg Med" "fecha" => "2005" "volumen" => "12" "paginaInicial" => "844" "paginaFinal" => "849" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16141018" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The “lung point”: An ultrasound sign specific to pneumothorax" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "D. Lichtenstein" 1 => "G. Meziere" 2 => "P. Biderman" 3 => "A. Gepner" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Intensive Care Med" "fecha" => "2000" "volumen" => "26" "paginaInicial" => "1434" "paginaFinal" => "1440" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11126253" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0045" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Occult traumatic pneumothorax: Diagnostic accuracy of lung ultrasonography in the emergency department" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "G. Soldati" 1 => "A. Testa" 2 => "S. Sher" 3 => "G. Pignataro" 4 => "M. La Sala" 5 => "N.G. Silveri" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1378/chest.07-1595" "Revista" => array:6 [ "tituloSerie" => "Chest" "fecha" => "2008" "volumen" => "133" "paginaInicial" => "204" "paginaFinal" => "211" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17925411" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0050" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Tracheotomy in children: Life saving of life taking" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "M. Glicklick" 1 => "D.S. Trump" 2 => "L.F. Snyder" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Marquette Med Rev" "fecha" => "1985" "volumen" => "31" "paginaInicial" => "177" "paginaFinal" => "180" ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0055" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pathogenesis Of Mediastinal Emphysema And Pneumothorax Following Tracheotomy: Experimental Approaches" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "I.F. Padman" 1 => "A. Dawson" 2 => "E. Henschel" 3 => "R.H. Lehrnan" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Chest" "fecha" => "1974" "volumen" => "66" "paginaInicial" => "553" "paginaFinal" => "556" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/4430206" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0060" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Miller and Mayer Sagy. Pressure Characteristics of Mechanical Ventilation and Incidence of Pneumothorax Before and After the Implementation of Protective Lung Strategies in the Management of Pediatric Patients With Severe ARDS" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "P. Michael" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1378/chest.08-0743" "Revista" => array:7 [ "tituloSerie" => "Chest" "fecha" => "2008 Nov" "volumen" => "134" "paginaInicial" => "969" "paginaFinal" => "973" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18689581" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0140673606694464" "estado" => "S300" "issn" => "01406736" ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0065" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Management of spontaneous pneumothorax" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "M.H. Baumann" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ccm.2005.12.006" "Revista" => array:7 [ "tituloSerie" => "Clin Chest Med" "fecha" => "2006" "volumen" => "27" "paginaInicial" => "369" "paginaFinal" => "381" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16716824" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0016508508015175" "estado" => "S300" "issn" => "00165085" ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0070" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Barotrauma during mechanical ventilation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A. Thille" 1 => "F. Lellouche" 2 => "L. Brochard" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Réanimation" "fecha" => "2005" "volumen" => "14" "paginaInicial" => "133" "paginaFinal" => "139" ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0075" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "MDCT quantification is the dominant parameter in decision-making regarding chest tube drainage for stable patients with traumatic pneumothorax" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "W. Cai" 1 => "J.G. Lee" 2 => "K. Fikry" 3 => "H. Yoshida" 4 => "R. Novelline" 5 => "M. de Moya" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.compmedimag.2012.03.005" "Revista" => array:6 [ "tituloSerie" => "Comput Med Imaging Graph" "fecha" => "2012 Jul" "volumen" => "36" "paginaInicial" => "375" "paginaFinal" => "386" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22560899" "web" => "Medline" ] ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0080" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Chest drainage tubes" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "P.N. Symbas" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Surg Clin North Am" "fecha" => "1989" "volumen" => "69" "paginaInicial" => "41" "paginaFinal" => "46" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2643182" "web" => "Medline" ] ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0085" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Insertion of a chest drain: how to do it" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "M.A. Tomlinson" 1 => "T. Treasure" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Br J Hosp Med" "fecha" => "1997" "volumen" => "58" "paginaInicial" => "248" "paginaFinal" => "252" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9488797" "web" => "Medline" ] ] ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0090" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Advanced Trauma Life Support for Doctors-–Student Course Manual. 7th ed. Chicago: American College of Surgeons, 2004." ] ] ] 18 => array:3 [ "identificador" => "bib0095" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "An evidence-based approach to drainage of the pleural cavity: evaluation of best practice" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A.T. Tang" 1 => "T.J. Velissaris" 2 => "D.F. Weeden" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Eval Clin Pract" "fecha" => "2002" "volumen" => "8" "paginaInicial" => "333" "paginaFinal" => "340" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12164980" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735115/0000001900000002/v1_201305151603/S2173511513000213/v1_201305151603/en/main.assets" "Apartado" => array:4 [ "identificador" => "9710" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Original articles" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735115/0000001900000002/v1_201305151603/S2173511513000213/v1_201305151603/en/main.pdf?idApp=UINPBA00004E&text.app=https://journalpulmonology.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173511513000213?idApp=UINPBA00004E"]

Statistics

Original

Iatrogenic pneumothorax: experience of a Moroccan Emergency Center

Pneumotórax Iatrogénico: experiência de um Centro de Emergência Marroquino

M.M. El Hammoumia,

Corresponding author

hamoumimassine@hotmail.fr

Corresponding author.

, G. Drissib, A. Achira, A. Benchekrounb, A. Benosmana

a Department of thoracic surgery, hospital Avicenne, Rabat, Morocco

b Department of Surgical emergencies, Hospital Avicenne, Rabat, Morocco

Read

1147

Times
was read the article

563

Total PDF

584

Total HTML

Share statistics

 array:24 [
  "pii" => "S2173511513000213"
  "issn" => "21735115"
  "doi" => "10.1016/j.rppnen.2013.03.002"
  "estado" => "S300"
  "fechaPublicacion" => "2013-03-01"
  "aid" => "122"
  "copyright" => "Sociedade Portuguesa de Pneumologia"
  "copyrightAnyo" => "2012"
  "documento" => "article"
  "crossmark" => 0
  "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
  "subdocumento" => "fla"
  "cita" => "Rev Port Pneumol. 2013;19:65-9"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:2 [
    "total" => 3431
    "formatos" => array:3 [
      "EPUB" => 247
      "HTML" => 2213
      "PDF" => 971
    ]
  ]
  "itemSiguiente" => array:19 [
    "pii" => "S2173511513000171"
    "issn" => "21735115"
    "doi" => "10.1016/j.rppnen.2013.02.006"
    "estado" => "S300"
    "fechaPublicacion" => "2013-03-01"
    "aid" => "119"
    "copyright" => "Sociedade Portuguesa de Pneumologia"
    "documento" => "article"
    "crossmark" => 0
    "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
    "subdocumento" => "fla"
    "cita" => "Rev Port Pneumol. 2013;19:70-5"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 5358
      "formatos" => array:3 [
        "EPUB" => 232
        "HTML" => 3714
        "PDF" => 1412
      ]
    ]
    "en" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>"
      "titulo" => "Evaluation of the oxidant and antioxidant balance in the pathogenesis of chronic obstructive pulmonary disease"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "pt"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "70"
          "paginaFinal" => "75"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "pt" => array:1 [
          "titulo" => "Avalia&#231;&#227;o do equil&#237;brio entre oxidantes e antioxidantes na patog&#233;nese da doen&#231;a pulmonar obstrutiva cr&#243;nica"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "pt" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0005"
          "etiqueta" => "Figure 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr1.jpeg"
              "Alto" => 818
              "Ancho" => 1382
              "Tamanyo" => 60403
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Levels of malondialdehyde &#40;MDA&#41; in plasma from control subjects and COPD patients&#46; Values are expressed as mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>SEM&#46; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001 significantly different between controls and whole COPD group&#46; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;01 significantly different between controls and non-smoker patients&#46; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001 significantly different between controls and ex-smoker patients&#46; There was no significant differences between non-smokers and ex-smokers COPD patients&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "C&#46; Crist&#243;v&#227;o, L&#46; Crist&#243;v&#227;o, F&#46; Nogueira, M&#46; Bicho"
          "autores" => array:4 [
            0 => array:2 [
              "nombre" => "C&#46;"
              "apellidos" => "Crist&#243;v&#227;o"
            ]
            1 => array:2 [
              "nombre" => "L&#46;"
              "apellidos" => "Crist&#243;v&#227;o"
            ]
            2 => array:2 [
              "nombre" => "F&#46;"
              "apellidos" => "Nogueira"
            ]
            3 => array:2 [
              "nombre" => "M&#46;"
              "apellidos" => "Bicho"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173511513000171?idApp=UINPBA00004E"
    "url" => "/21735115/0000001900000002/v1_201305151603/S2173511513000171/v1_201305151603/en/main.assets"
  ]
  "itemAnterior" => array:19 [
    "pii" => "S2173511513000201"
    "issn" => "21735115"
    "doi" => "10.1016/j.rppnen.2013.03.001"
    "estado" => "S300"
    "fechaPublicacion" => "2013-03-01"
    "aid" => "130"
    "copyright" => "Sociedade Portuguesa de Pneumologia"
    "documento" => "article"
    "crossmark" => 0
    "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
    "subdocumento" => "fla"
    "cita" => "Rev Port Pneumol. 2013;19:59-64"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 3915
      "formatos" => array:3 [
        "EPUB" => 248
        "HTML" => 2635
        "PDF" => 1032
      ]
    ]
    "en" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>"
      "titulo" => "Surgical lung biopsy for diffuse lung disease&#46; Our experience in the last 15 years"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "pt"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "59"
          "paginaFinal" => "64"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "pt" => array:1 [
          "titulo" => "Bi&#243;psia pulmonar cir&#250;rgica na doen&#231;a pulmonar difusa&#46; A nossa experi&#234;ncia nos &#250;ltimos 15 anos"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "pt" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0010"
          "etiqueta" => "Figure 2"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr2.jpeg"
              "Alto" => 1614
              "Ancho" => 2139
              "Tamanyo" => 99276
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Distribution of the number of lung biopsies performed between 1997 and 2011&#46; Notice how from the year 2004 &#40;arrow&#41; there is a decreased in the number of biopsies performed&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "M&#46; Blanco, G&#46;A&#46; Obeso, J&#46;C&#46; Dur&#225;n, J&#46;E&#46; Rivo, E&#46; Garc&#237;a-Font&#225;n, E&#46; Pe&#241;a, M&#46; Rodr&#237;guez, J&#46; Albort, M&#46;A&#46; Ca&#241;izares"
          "autores" => array:9 [
            0 => array:2 [
              "nombre" => "M&#46;"
              "apellidos" => "Blanco"
            ]
            1 => array:2 [
              "nombre" => "G&#46;A&#46;"
              "apellidos" => "Obeso"
            ]
            2 => array:2 [
              "nombre" => "J&#46;C&#46;"
              "apellidos" => "Dur&#225;n"
            ]
            3 => array:2 [
              "nombre" => "J&#46;E&#46;"
              "apellidos" => "Rivo"
            ]
            4 => array:2 [
              "nombre" => "E&#46;"
              "apellidos" => "Garc&#237;a-Font&#225;n"
            ]
            5 => array:2 [
              "nombre" => "E&#46;"
              "apellidos" => "Pe&#241;a"
            ]
            6 => array:2 [
              "nombre" => "M&#46;"
              "apellidos" => "Rodr&#237;guez"
            ]
            7 => array:2 [
              "nombre" => "J&#46;"
              "apellidos" => "Albort"
            ]
            8 => array:2 [
              "nombre" => "M&#46;A&#46;"
              "apellidos" => "Ca&#241;izares"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173511513000201?idApp=UINPBA00004E"
    "url" => "/21735115/0000001900000002/v1_201305151603/S2173511513000201/v1_201305151603/en/main.assets"
  ]
  "en" => array:19 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Original</span>"
    "titulo" => "Iatrogenic pneumothorax&#58; experience of a Moroccan Emergency Center"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "65"
        "paginaFinal" => "69"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "M&#46;M&#46; El Hammoumi, G&#46; Drissi, A&#46; Achir, A&#46; Benchekroun, A&#46; Benosman"
        "autores" => array:5 [
          0 => array:4 [
            "nombre" => "M&#46;M&#46;"
            "apellidos" => "El Hammoumi"
            "email" => array:1 [
              0 => "hamoumimassine&#64;hotmail&#46;fr"
            ]
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">¿</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "G&#46;"
            "apellidos" => "Drissi"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "A&#46;"
            "apellidos" => "Achir"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          3 => array:3 [
            "nombre" => "A&#46;"
            "apellidos" => "Benchekroun"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
          4 => array:3 [
            "nombre" => "A&#46;"
            "apellidos" => "Benosman"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:2 [
          0 => array:3 [
            "entidad" => "Department of thoracic surgery&#44; hospital Avicenne&#44; Rabat&#44; Morocco"
            "etiqueta" => "<span class="elsevierStyleSup">a</span>"
            "identificador" => "aff0005"
          ]
          1 => array:3 [
            "entidad" => "Department of Surgical emergencies&#44; Hospital Avicenne&#44; Rabat&#44; Morocco"
            "etiqueta" => "<span class="elsevierStyleSup">b</span>"
            "identificador" => "aff0010"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "pt" => array:1 [
        "titulo" => "Pneumot&#243;rax Iatrog&#233;nico&#58; experi&#234;ncia de um Centro de Emerg&#234;ncia Marroquino"
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:6 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 897
            "Ancho" => 900
            "Tamanyo" => 123549
          ]
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Introduction&#58;</span><p id="par0005" class="elsevierStylePara elsevierViewall">Pneumothorax is a serious but common complication of invasive chest procedures&#46; Several procedures were identified as causing pneumothorax&#44; but according to the literature the most frequent causes are thoracocentesis&#44;central venous cannulation and barotraumas&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">In the present climate of increased use of invasive procedures&#44; the incidence of iatrogenic pneumothorax &#40;IPx&#41; is going to increase particularly in training hospitals&#46; It is for this reason that we want assess and delineate retrospectively the common diagnostic or therapeutic causes of IPx and its impact on morbidity&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Materials and methods&#58;</span><p id="par0015" class="elsevierStylePara elsevierViewall">From January 2011 to December 2012&#44; we listed 36 cases of patients who developed IPx in the emergency department&#44; after an invasive procedure for diagnostic or therapeutic purposes&#46; For each patient was details of age&#44; gender&#44; the invasive procedure which caused IPnx&#44; the specific treatment and consequences were recorded&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Results&#58;</span><p id="par0020" class="elsevierStylePara elsevierViewall">The mean age was 38 years &#40;range&#58; 19-69 years&#41;&#46; Twenty one &#40;58&#37;&#41; of the patients were male and 15 &#40;42&#37;&#41; were female&#46; All the invasive procedures which caused IPnx were performed under as emergencies in the Emergency Department&#46; The purpose of the invasive procedure was diagnostic in 6 cases and therapeutic in 30 cases&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">8 patients &#40;22&#37;&#41; had procedures for underlying lung or tracheal diseases and 28 patients &#40;78&#37;&#41; for other diseases&#46; &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">The procedure type most frequently causing IPnx was subclavian and jugular central venous catheterization&#59; 20 patients &#40;55&#37;&#41; &#40;right side&#59; n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>15&#44;left side&#59; n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>5&#41;&#46; The other frequent causes were barotraumatism due to mechanical ventilation &#40;<a class="elsevierStyleCrossRef" href="#fig0005">figure 1</a>&#41;&#59; 8 cases &#40;22&#37;&#41;&#46; Of this 8 there were 3 cases with bilateral pneumothorax&#44; 6 cases of thoracentesis &#40;16&#37;&#41; and in 2 patients had life-saving percutaneous tracheotomy&#46; &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">Clinical signs compatible with a pneumothorax were found in all patients with associated radiographic signs&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Percutaneous tracheotomies were performed by the physician &#40;not a surgeon&#41; who admitted the patient and indicated a life saving tracheotomy in the intensive care unit&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">According to our protocol&#44; once the invasive procedure is accomplished a systematic chest radiograph is taken&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Regardless of the causal procedure&#44; and depending on patient stability and the size of the pneumothorax the majority &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>33&#44; 91&#44;6&#37;&#41; of our patients were managed by a small chest tube placement &#40;unilateral n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>30&#44; bilateral n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#41;&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">The chest tube placement was performed by a trained physician&#44; using either the ventral approach &#40;2&#46;-3&#46; Intercostals space&#41; in the mid-clavicular line&#58; also called the approach according to Monaldi &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>8&#44; chest tube Joly size 16&#41;&#44; or the lateral approach &#40;4&#46;-6&#46; intercostal space&#41; in the anterior to mid-axillary line also called the approach according to Bulau&#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>28&#44; chest tube Joly size16-18&#41; The tube is connected to a bottle or canister&#46; Suction is often used to help it drain&#46; Otherwise&#44; gravity alone will allow it to drain&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Once the drain was in place&#44; a chest radiograph was taken to check the location of the drain&#46; The tube stayed in for as long as there was air or fluid to be removed&#44; or the risk of air gathering&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Clinical malfunction of the tube with a radiological malposition was noted in 6 cases with a chest tube replacement by a larger size chest tube &#40;Joly size 18&#41;&#46; Malfunction was due to the interlobar placement of the tube&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">The average of duration of drainage was 3 days &#40;range&#58; 1-15days&#41;&#44; sadly one of our patients died of ischemic brain damage 15 days after percutaneous tracheotomy&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Hospitalization was prolonged due to this treatment in only 10 cases&#44; presumably because of the underlying disease which required long hospitalization&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Discussion&#58;</span><p id="par0080" class="elsevierStylePara elsevierViewall">To the best of our knowledge Iatrogenous Pneumothorax has very rarely been reported in the English literature&#44; we entered &#8220;pneumothorax&#8221; AND &#8220;Iatrogenous&#8221; in Pubmed and there were no retrospective or prospective studies about the incidence of this complication which is one of the most common complications of invasive chest procedures&#46; The morbidity associated with pneumothorax&#44; particularly with a chest tube placement&#44; should be a warning to physicians to avoid all unnecessary pneumothorax-related procedures especially in emergencies&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Careful choice of the site for percutaneous central vascular access is recommended&#44; the internal jugular vein is preferable because of the lower frequency of related pneumothorax&#44; 7 IPx of 424 subclavian puncture site in the study of Pikwer<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>&#44; and 4 IPx of 1552jugular puncture in the same study &#46; Eisen and al&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> obtained similar results and concluded that a higher risk of pneumothorax was associated with the subclavian puncture&#44; in our study 12 of the 20 patients had a subclavian approach&#44; which is explained by anatomical proximity of sub clavian vessels to the pleural space and the greater familiarity of physicians with this site but Shummer and &#46;Al<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> noted in a prospective study of 1794 catheterizations similar risk of IPx in subclavian and internal jugular site&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Thoracocentesis in order to evacuate recurrent or large pleural effusions is traditionally a safe procedure when performed by an experienced operator&#46; IPx occurred in 19&#37; in the study of Grogan and Al<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a>&#44; and 5&#44;1&#37; in the recent study of Henry and Al<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a>&#46; However the latter found no statistically significant association between the occurrence of pneumothorax and the type of needle used&#44; the size of the effusion&#44; the amount of fluid drained&#44; the presence of loculations&#44; the type of thoracentesis&#44; or the experience of the operator&#46; All our thoracocentesis-related pneumothorax were performed by training operators so we conclude that thoracocentesis can be difficult and needs a controlled setting&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">In our study&#44; we did not use ultrasound control after six thoracocentesis but a chest radiograph control &#46;However&#44; several studies have demonstrated high sensitivity and specificity for thoracic ultrasound in detecting of occult pneumothorax in critical care&#44;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> and trauma patients&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> The absence of lung sliding suggests pneumothorax&#44; but it can occur in manyultiple other conditions such as mainstem intubation&#44; acute respiratory distress syndrome&#44; or pleural adhesions&#46; The &#8220;lung point&#8221; is an ultrasound sign with 100&#37; specificity for pneumothorax&#44;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> and can be used to determine the size of the pneumothorax&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a></p><p id="par0100" class="elsevierStylePara elsevierViewall">Very few studies have been published about the role of tracheotomy in the pathogenesis of pneumothorax&#46; Glicklick and All <a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> reported 17&#37; IPx in his earlier study of 45 tracheotomies&#46; Pneumothorax is more significantly possible when tracheotomy is an emergency <a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a>&#46; Some authors<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> proved experimentally the mechanism of pneumothorax via a pneumomediastinum secondary to air way hyper pressure during tracheotomy and surgery&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Complications with mechanical ventilation are common&#44; and rupture of the pulmonary alveoli or airways after a sudden increase of intra-alveolar pressure is a common cause of pneumothorax&#46; The incidence of pneumothorax during ARDS is less than 10&#37; since the reduction of tidal volume and limiting plateau pressure&#46; The more aggressive use of ventilator pressure characteristics was found to be associated with a higher incidence of pneumothorax&#44; 17&#37; in the study of Miller<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> who noted the major role of protective lung strategy&#46; In our study&#44; the 8 cases with barotraumatisms had an associated Acute Respiratory Distress Syndrome and lung obstructive disease which increased the side effects of mechanical ventilation&#46; An existing lung disease such as Chronic Obstructive Pulmonary Disease &#40;COPD&#41;&#44; or asthma is the most common cause of a greater associated incidence of pneumothorax after positive pressure ventilation&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> These patients have generally bleb or bulla due to airway obstruction&#46; Acute respiratory distress syndrome &#40;ARDS&#41; is defined by bilateral pulmonary infiltrates with a decreased lung compliance responsible for high alveolar pressure even using low tidal volume&#46; Chest X-ray or Computed Tomography is used to detect the air leak&#58; pneumothorax or pneumomediastinum with possible risk of heamodynamic complications&#46; Risk factors associated with barotrauma are the underlying disease for mechanical ventilation and a high airway pressure during mechanical ventilation<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a>&#46; Alveolar pressure&#44; obtained by measuring plateau pressure at the end of the inspiration&#44; is the best tool for evaluating the risk of alveolar barotrauma&#46; This pressure must be kept below 30<span class="elsevierStyleHsp" style=""></span>cmH2O&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">Barotraumatic pneumothorax was managed by chest tube placement to prevent tension pneumothorax and heamodynamic complication s and in our cases the time the chest tube was in place was longer &#40;4 days&#41;&#46;We use a preventive protocol in mechanic ventilation to avoid alveolar hyperpressure depending on the underlying lung disease and severity of the ARDS&#58; a controlled low tidal volume ventilation is taken&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">It is commonly believed that the size of a pneumothorax is an important determinant of treatment decision particularly as to whether chest tube drainage is required&#46; In our practice we still use clinical and chest radiological data to take a decision&#44; however&#44; a volumetric quantification of pneumothoraces has been performed in a Chinese study <a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> by automated computer-aided volumetry in CT images&#46; The results indicated that the inclusion of volume made it the most statistically significant indicators compared to the other tests in which volume was excluded from the clinical parameters<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a>&#46; This study provides the evidence for the application of volumetric quantification of pneumothoraces in the management of clinically stable chest trauma patients with traumatic pneumothorax but it is based on computed tomography images which are not a systematic part of our practice&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Most authors recommend the lateral approach for chest tube insertion&#46;<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">16&#44;17</span></a> without data documenting why they advise against using the ventral approach&#46; To the best of our knowledge there are no studies which just examine the ventral approach or investigate differences between the two common approaches&#46; Some authors recommend that if an approach other than the lateral is chosen then it should be performed by a thoracic surgeon<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">18&#44;19</span></a>&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">The ATLS manual recommends that the chest tube should &#8220;usually&#8221; be inserted via the lateral approach&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> &#46;In our protocol&#44; to avoid the potential risk of lacerating the internal mammary artery and to have a safer intercostals space for preparation we use the lateral approach which is frequently described as a &#8220;safe zone&#8221;&#46; We reserve the ventral approach for anterior pneumothoraces&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conclusion</span><p id="par0130" class="elsevierStylePara elsevierViewall">This review summarizes the current state of etiologies of IPx&#46; Another factor is that we had many attending physicians on-scene&#46; The influence of differing individual skills and different levels of familiarity with invasive procedures can affect the incidence of iatrogenous complications&#46; So it is advisable to use ultrasound guidance whenever possible for central venous cannulation or thorcocentesis&#46; If pneumothorax occurs&#44; it is important to recognize the signs and symptoms particularly during mechanical ventilation or with underlying lung disease&#46; A chest X-ray should be promptly done&#46; Depending on its size and symptoms&#44; treatment can vary from simple observation to a chest tube placement to be performed by experienced personnel or under their supervision even at training hospitals&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Ethic disclosures</span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Protection of human and animal subjects</span><p id="par0135" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this investigation&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Confidentiality of Data</span><p id="par0140" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appears in this article&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Right to privacy and informed consent</span><p id="par0145" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appears in this article&#46;</p></span></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflicts of interest</span><p id="par0150" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:12 [
        0 => array:2 [
          "identificador" => "xres175798"
          "titulo" => "Abstract"
        ]
        1 => array:2 [
          "identificador" => "xpalclavsec164131"
          "titulo" => "Keywords"
        ]
        2 => array:2 [
          "identificador" => "xres175797"
          "titulo" => "Resumo"
        ]
        3 => array:2 [
          "identificador" => "xpalclavsec164132"
          "titulo" => "Palavras chave"
        ]
        4 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Introduction&#58;"
        ]
        5 => array:2 [
          "identificador" => "sec0010"
          "titulo" => "Materials and methods&#58;"
        ]
        6 => array:2 [
          "identificador" => "sec0015"
          "titulo" => "Results&#58;"
        ]
        7 => array:2 [
          "identificador" => "sec0020"
          "titulo" => "Discussion&#58;"
        ]
        8 => array:2 [
          "identificador" => "sec0025"
          "titulo" => "Conclusion"
        ]
        9 => array:3 [
          "identificador" => "sec0030"
          "titulo" => "Ethic disclosures"
          "secciones" => array:3 [
            0 => array:2 [
              "identificador" => "sec0035"
              "titulo" => "Protection of human and animal subjects"
            ]
            1 => array:2 [
              "identificador" => "sec0040"
              "titulo" => "Confidentiality of Data"
            ]
            2 => array:2 [
              "identificador" => "sec0045"
              "titulo" => "Right to privacy and informed consent"
            ]
          ]
        ]
        10 => array:2 [
          "identificador" => "sec0050"
          "titulo" => "Conflicts of interest"
        ]
        11 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2012-07-24"
    "fechaAceptado" => "2012-11-08"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec164131"
          "palabras" => array:3 [
            0 => "Pneumothorax"
            1 => "Iatrogenic"
            2 => "Drainage"
          ]
        ]
      ]
      "pt" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palavras chave"
          "identificador" => "xpalclavsec164132"
          "palabras" => array:3 [
            0 => "Pneumot&#243;rax"
            1 => "Iatrog&#233;nico"
            2 => "Drenagem"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The incidence of iatrogenic pneumothorax &#40;IPx&#41; will increase with invasive procedures particularly at training hospitals&#44; which is why we have made a retrospective study of the common diagnostic or therapeutic causes of IPx and its impact on morbidity&#46; From January 2011 to December 2012&#44; 36 patients developed IPx as emergencies&#44; after an invasive procedure &#46;Their mean age was 38 years &#40;range&#58; 19-69 years&#41;&#46; Of the patients&#44; 21 &#40;58&#37;&#41; were male and 15 &#40;42&#37;&#41; were female&#46; The purpose was diagnostic in 6 cases and therapeutic in 30 cases&#46; In 8 patients &#40;22&#37;&#41; the procedure was performed due to underlying lung diseases and in 28 patients &#40;78&#37;&#41; for other diseases&#46; The procedure most frequently causing IPnx was central venous catheterization&#44; with 20 patients &#40;55&#37;&#41;&#44; other frequent causes were mechanical ventilation&#44; 8 cases &#40;22&#37;&#41; of whom we reported 3 cases of bilateral pneumothorax&#44; 6 cases of thoracentesis &#40;16&#37;&#41; and 2 patients had life-saving percutaneous tracheotomy&#46; The majority of our patients were managed by a small chest tube placement &#40;unilateral n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>30&#44; bilateral n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#41;&#46;The average duration of drainage was 3 days &#40;range&#58; 1-15 days&#41;&#44; sadly one of our patients died of ischemic brain damage 15 days after tracheotomy&#46;</p><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">At training hospitals the incidence of IPnx will increase with the increase in invasive procedures&#44; which should only be performed by experienced personnel or under their supervision&#46;</p>"
      ]
      "pt" => array:2 [
        "titulo" => "Resumo"
        "resumen" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A incid&#234;ncia de pneumot&#243;rax iatrog&#233;nico &#40;IPx&#41; vai aumentar com procedimentos invasivos particularmente em hospitais de forma&#231;&#227;o&#44; sendo esse o motivo pelo qual fizemos um estudo retrospetivo do diagn&#243;stico ou das causas terap&#234;uticas comuns de IPx e do seu impacto na morbidade&#46; Desde janeiro de 2011 at&#233; dezembro de 2012&#44; 36 pacientes desenvolveram IPx como emerg&#234;ncias&#44; depois de um procedimento invasivo&#46; A sua m&#233;dia de idades foi de 38 anos &#40;intervalo&#58; 19-69 anos&#41;&#46; Dos pacientes&#44; 21 &#40;58&#37;&#41; eram do sexo masculino e 15 &#40;42&#37;&#41; do sexo feminino&#46; O objetivo era diagn&#243;stico em 6 casos e terap&#234;utico em 30 casos&#46; Em 8 pacientes &#40;22&#37;&#41; do procedimento foi realizado devido a doen&#231;as pulmonares subjacentes e em 28 pacientes &#40;78&#37;&#41; por outras doen&#231;as&#46; O procedimento que mais frequentemente provocou IPnx foi cateteriza&#231;&#227;o venosa central&#44; com 20 doentes &#40;55&#37;&#41;&#44; outras causas frequentes foram a ventila&#231;&#227;o mec&#226;nica&#44; 8 casos &#40;22&#37;&#41; dos quais foram relatados 3 casos de pneumot&#243;rax bilateral&#44; 6 casos de toracocentese &#40;16&#37;&#41; e 2 pacientes traqueotomia percut&#226;nea de socorro&#46; A maioria dos nossos pacientes foram administrados pela coloca&#231;&#227;o de um pequeno dreno de t&#243;rax &#40;unilateral n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>30&#44; bilateral n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#41;&#46; A dura&#231;&#227;o m&#233;dia da drenagem foi de 3 dias &#40;intervalo&#58; 1-15 dias&#41;&#44; tendo infelizmente um dos nossos pacientes falecido devido a dano cerebral isqu&#233;mico&#44; 15 dias ap&#243;s a traqueotomia&#46;</p><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Em hospitais de forma&#231;&#227;o a incid&#234;ncia de IPnx aumentar&#225; com o cada vez maior n&#250;mero de procedimentos invasivos&#44; que apenas devem ser desempenhados por pessoal experiente ou sob a supervis&#227;o do mesmo&#46;</p>"
      ]
    ]
    "multimedia" => array:3 [
      0 => array:6 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 897
            "Ancho" => 900
            "Tamanyo" => 123549
          ]
        ]
      ]
      1 => array:7 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Number of Invasive procedure for Diagnostic purpose&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Number of Invasive procedure for Therapeutic Purpose&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Spontaneous Pleural effusion &#40;HVC-hepatic cirrhosis&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Thoracocentesis&#58; 6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Trauma without pleural effusion&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Venous central catheter&#58; 17 Mechanical ventilation&#58; 3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Respiratory failure &#40;lung disease&#44; BPCO&#44; asthm&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Mechanical ventilation&#58; 5 Venous central catheter&#58; 3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Facial trauma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Tracheotomy&#58; 2 Mechanical ventilation&#58; 2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab268177.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">diseases associated with the iatrogenous pneumthorax&#46;</p>"
        ]
      ]
      2 => array:7 [
        "identificador" => "tbl0010"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cause of IPx&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">n &#40;number of cases&#41;</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Right IPx&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Left IPx&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Bilateral IPx&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Central venous catheterization&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">20</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Subclavian puncture&#58; 12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Jugular puncture&#58; 8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Barotraumatism&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Thoracentesis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Percutaneous tracheotomy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab268176.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Invasive procedures associated with iatrogenous pneumothorax&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:19 [
            0 => array:3 [
              "identificador" => "bib0005"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Routine chest X-ray is not required after a low-risk central venous cannulation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "A&#46; Pikwer"
                            1 => "I&#46; Perstoft"
                            2 => "B&#46; Davidson"
                            3 => "J&#46; Keson"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1399-6576.2009.01980.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Acta Anaesthesiol Scand"
                        "fecha" => "2009"
                        "volumen" => "53"
                        "paginaInicial" => "1145"
                        "paginaFinal" => "1152"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19422354"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0010"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Mechanical complications of central venous catheters"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "L&#46;A&#46; Eisen"
                            1 => "M&#46; Narasimhan"
                            2 => "J&#46;S&#46; Berger"
                            3 => "P&#46;H&#46; Mayo"
                            4 => "M&#46;J&#46; Rosen"
                            5 => "R&#46;F&#46; Schneider"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1177/0885066605280884"
                      "Revista" => array:7 [
                        "tituloSerie" => "J Intensive Care Med"
                        "fecha" => "2006"
                        "volumen" => "21"
                        "paginaInicial" => "40"
                        "paginaFinal" => "46"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16698743"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0016508509011640"
                          "estado" => "S300"
                          "issn" => "00165085"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0015"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Mechanical complications and malpositions of central venous cannulations by experienced operators&#46; A prospective study of 1794 catheterizations in critically ill patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "SchummerW"
                            1 => "C&#46; Schummer"
                            2 => "N&#46; Rose"
                            3 => "W&#46;D&#46; Niesen"
                            4 => "S&#46;G&#46; Sakka"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00134-007-0560-z"
                      "Revista" => array:7 [
                        "tituloSerie" => "Intensive Care Med"
                        "fecha" => "2007"
                        "volumen" => "33"
                        "paginaInicial" => "1055"
                        "paginaFinal" => "1059"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17342519"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S1470204509702062"
                          "estado" => "S300"
                          "issn" => "14702045"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0020"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Complications associated with thoracentesis&#58; a prospective randomized study comparing three different methods"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "D&#46;R&#46; Grogan"
                            1 => "R&#46;S&#46; Irwin"
                            2 => "R&#46; Channick"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "Arch Intern Med"
                        "fecha" => "1990"
                        "volumen" => "150"
                        "paginaInicial" => "873"
                        "paginaFinal" => "877"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2183735"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0959804909001245"
                          "estado" => "S300"
                          "issn" => "09598049"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0025"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Colt&#44; Nancy Brewer and Edward Barbur"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "G&#46; Henri"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Evaluation of Patient-Related and Procedure-Related Factors Contributing to Pneumothorax Following Thoracentesis Chest"
                        "fecha" => "1999"
                        "volumen" => "116"
                        "paginaInicial" => "134"
                        "paginaFinal" => "138"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0030"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Ultrasound diagnosis of occult pneumothorax"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "D&#46;A&#46; Lichtenstein"
                            1 => "G&#46; Mezi&#232;re"
                            2 => "N&#46; Lascola"
                            3 => "P&#46; Biderman"
                            4 => "J&#46;P&#46; Courret"
                            5 => "A&#46; Gepner"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Crit Care Med"
                        "fecha" => "2005"
                        "volumen" => "33"
                        "paginaInicial" => "1231"
                        "paginaFinal" => "1238"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15942336"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0035"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A prospective comparison of supine chest radiography and bedside ultrasound for the diagnosis of traumatic pneumothorax"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "M&#46; Blaivas"
                            1 => "M&#46; Lyon"
                            2 => "S&#46; Duggal"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1197/j.aem.2005.05.005"
                      "Revista" => array:6 [
                        "tituloSerie" => "Acad Emerg Med"
                        "fecha" => "2005"
                        "volumen" => "12"
                        "paginaInicial" => "844"
                        "paginaFinal" => "849"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16141018"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0040"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The &#8220;lung point&#8221;&#58; An ultrasound sign specific to pneumothorax"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "D&#46; Lichtenstein"
                            1 => "G&#46; Meziere"
                            2 => "P&#46; Biderman"
                            3 => "A&#46; Gepner"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Intensive Care Med"
                        "fecha" => "2000"
                        "volumen" => "26"
                        "paginaInicial" => "1434"
                        "paginaFinal" => "1440"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11126253"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0045"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Occult traumatic pneumothorax&#58; Diagnostic accuracy of lung ultrasonography in the emergency department"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "G&#46; Soldati"
                            1 => "A&#46; Testa"
                            2 => "S&#46; Sher"
                            3 => "G&#46; Pignataro"
                            4 => "M&#46; La Sala"
                            5 => "N&#46;G&#46; Silveri"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1378/chest.07-1595"
                      "Revista" => array:6 [
                        "tituloSerie" => "Chest"
                        "fecha" => "2008"
                        "volumen" => "133"
                        "paginaInicial" => "204"
                        "paginaFinal" => "211"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17925411"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0050"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Tracheotomy in children&#58; Life saving of life taking"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "M&#46; Glicklick"
                            1 => "D&#46;S&#46; Trump"
                            2 => "L&#46;F&#46; Snyder"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Marquette Med Rev"
                        "fecha" => "1985"
                        "volumen" => "31"
                        "paginaInicial" => "177"
                        "paginaFinal" => "180"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0055"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pathogenesis Of Mediastinal Emphysema And Pneumothorax Following Tracheotomy&#58; Experimental Approaches"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "I&#46;F&#46; Padman"
                            1 => "A&#46; Dawson"
                            2 => "E&#46; Henschel"
                            3 => "R&#46;H&#46; Lehrnan"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Chest"
                        "fecha" => "1974"
                        "volumen" => "66"
                        "paginaInicial" => "553"
                        "paginaFinal" => "556"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/4430206"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0060"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Miller and Mayer Sagy&#46; Pressure Characteristics of Mechanical Ventilation and Incidence of Pneumothorax Before and After the Implementation of Protective Lung Strategies in the Management of Pediatric Patients With Severe ARDS"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "P&#46; Michael"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1378/chest.08-0743"
                      "Revista" => array:7 [
                        "tituloSerie" => "Chest"
                        "fecha" => "2008 Nov"
                        "volumen" => "134"
                        "paginaInicial" => "969"
                        "paginaFinal" => "973"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18689581"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0140673606694464"
                          "estado" => "S300"
                          "issn" => "01406736"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0065"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Management of spontaneous pneumothorax"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "M&#46;H&#46; Baumann"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ccm.2005.12.006"
                      "Revista" => array:7 [
                        "tituloSerie" => "Clin Chest Med"
                        "fecha" => "2006"
                        "volumen" => "27"
                        "paginaInicial" => "369"
                        "paginaFinal" => "381"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16716824"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0016508508015175"
                          "estado" => "S300"
                          "issn" => "00165085"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0070"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Barotrauma during mechanical ventilation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "A&#46; Thille"
                            1 => "F&#46; Lellouche"
                            2 => "L&#46; Brochard"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "R&#233;animation"
                        "fecha" => "2005"
                        "volumen" => "14"
                        "paginaInicial" => "133"
                        "paginaFinal" => "139"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0075"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "MDCT quantification is the dominant parameter in decision-making regarding chest tube drainage for stable patients with traumatic pneumothorax"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "W&#46; Cai"
                            1 => "J&#46;G&#46; Lee"
                            2 => "K&#46; Fikry"
                            3 => "H&#46; Yoshida"
                            4 => "R&#46; Novelline"
                            5 => "M&#46; de Moya"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.compmedimag.2012.03.005"
                      "Revista" => array:6 [
                        "tituloSerie" => "Comput Med Imaging Graph"
                        "fecha" => "2012 Jul"
                        "volumen" => "36"
                        "paginaInicial" => "375"
                        "paginaFinal" => "386"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22560899"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0080"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Chest drainage tubes"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "P&#46;N&#46; Symbas"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Surg Clin North Am"
                        "fecha" => "1989"
                        "volumen" => "69"
                        "paginaInicial" => "41"
                        "paginaFinal" => "46"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2643182"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib0085"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Insertion of a chest drain&#58; how to do it"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "M&#46;A&#46; Tomlinson"
                            1 => "T&#46; Treasure"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Br J Hosp Med"
                        "fecha" => "1997"
                        "volumen" => "58"
                        "paginaInicial" => "248"
                        "paginaFinal" => "252"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9488797"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib0090"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Advanced Trauma Life Support for Doctors-&#8211;Student Course Manual&#46; 7th ed&#46; Chicago&#58; American College of Surgeons&#44; 2004&#46;"
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib0095"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "An evidence-based approach to drainage of the pleural cavity&#58; evaluation of best practice"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "A&#46;T&#46; Tang"
                            1 => "T&#46;J&#46; Velissaris"
                            2 => "D&#46;F&#46; Weeden"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Eval Clin Pract"
                        "fecha" => "2002"
                        "volumen" => "8"
                        "paginaInicial" => "333"
                        "paginaFinal" => "340"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12164980"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/21735115/0000001900000002/v1_201305151603/S2173511513000213/v1_201305151603/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "9710"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Original articles"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/21735115/0000001900000002/v1_201305151603/S2173511513000213/v1_201305151603/en/main.pdf?idApp=UINPBA00004E&text.app=https://journalpulmonology.org/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173511513000213?idApp=UINPBA00004E"
]

Article information

ISSN: 21735115
Original language: English

DOI:10.1016/j.rppnen.2013.03.002

The statistics are updated each day

Year/Month	Html	Pdf	Total

2024 November	7	6	13
2024 October	19	43	62
2024 September	30	22	52
2024 August	36	42	78
2024 July	37	34	71
2024 June	33	26	59
2024 May	36	40	76
2024 April	36	29	65
2024 March	43	34	77
2024 February	27	33	60
2024 January	26	33	59
2023 December	13	34	47
2023 November	29	29	58
2023 October	24	28	52
2023 September	20	31	51
2023 August	22	23	45
2023 July	30	29	59
2023 June	38	11	49
2023 May	58	27	85
2023 April	20	9	29

Show all

Indexed in:

Follow us:

Statistics

Indexed in:

Follow us:

Statistics

Subscribe to our newsletter