Let's take a look at the CT scan images first.
Only a tension pneumothorax can cause such pulmonary compression.What would happen if such a patient with pneumothorax were nothing done about it and directly subjected to hyperbaric oxygen therapy?
This is a 49-year-old middle-aged woman who was scheduled for a lung tumor resection due to a lung mass. During preoperative preparation, a neck vein catheterization was performed. A few minutes after the operation, the patient's heart and breathing suddenly stopped. At that time, immediate tracheal intubation, ventilator-assisted ventilation, and chest compression were administered. Five minutes later, cardiac resuscitation was successful, but there was still no spontaneous breathing. CT showed significant cerebral edema. The surgeon immediately contacted our hospital's hyperbaric oxygen cerebral resuscitation center and requested comprehensive hyperbaric oxygen treatment. It was also requested that the treatment be carried out first in the hyperbaric oxygen chamber and then transferred to the ward. Because there are no hospital beds, the patient was transferred to our hospital two days later and began hyperbaric oxygen treatment.
The treatment plan we chose was 20 minutes of pressurization, maintaining pressure at 2.4 ATA for 95 minutes, and then depressurization for 20 minutes.
During hyperbaric oxygen therapy, it was found that the patient‘s blood oxygen saturation was occasionally less than 100% (Generally speaking，during hyperbaric oxygen therapy, the patient’s blood oxygen saturation should be 100% unless there are special circumstances). The cause was investigated and it was discovered that the bilateral breath sounds were low, the bilateral chest percussion was tympanic, the bilateral thoracic cavities were significantly expanded, and the skin surface was tight and bright. During the neck examination, the trachea was found to be centered. It was initially judged that the patient had pneumothorax. Immediately, the personnel outside the chamber were notified to deliver the thoracic puncture kit into the chamber. If necessary, thoracic puncture with closed drainage would be performed at any time. As a result, the blood oxygen saturation remained above 90% throughout the treatment process.
After leaving the chamber, an chest CT scan was immediately performed in the CT room. It was found that there was a large amount of pneumothorax on both sides, with bilateral lung compression ranging from 80% to 70% (as shown in the figure above).
When did the pneumothorax occur? Was it during the puncture? During the resuscitation? During the transportation? Or during the hyperbaric oxygen treatment? After discussion, although it was impossible to completely rule out the possibility of pneumothorax occurring at other times, the possibility of it occurring during the puncture was the greatest. That is to say, such a patient with pneumothorax also received one round of hyperbaric oxygen treatment.
After returning to the ward, bilateral thoracentesis and closed drainage were immediately prepared. Please see the picture. If punctured on the left side, due to the reduction of pressure on the left side, the mediastinum would move to the left; if punctured on the right side, the mediastinum would move to the right. Such a significant movement of the mediastinum might cause cardiac arrest. To avoid cardiac arrest caused by such a significant movement of the mediastinum, we chose the method of puncturing both thoracic cavities simultaneously.
Under the order of the director, two doctors simultaneously performed thoracentesis. The entire puncture process was smooth. Please see the video:
The subsequent hyperbaric oxygen treatment was carried out under the condition of ventilator-assisted ventilation, pressor drugs to maintain circulation, and bilateral thoracic closed drainage.
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