Pneumothorax and chest drain insertion

A pneumothorax is caused by air or gas in the pleural space. This causes lung collapse and a variable degree of impairment of both oxygenation and ventilation. Depending on the degree of lung collapse (determined by the size of the pneumothorax) and the underlying respiratory reserve and co-morbidities of the patient the clinical picture can vary from asymptomatic to life-threatening. The initial management varies with the clinical picture as well as the aetiology and size of the pneumothorax. It ranges from observation only (for small primary spontaneous pneumothorax), to needle aspiration or chest drain insertion. Chest drain insertion is a common procedure used routinely to not only drain the chest cavity of air as is the case with a pneumothorax but is also used to drain blood (haemothorax), chyle (chylothorax), pleural fluid or pus (empyema) from the chest cavity. It is the most common procedure in thoracic trauma and both Seldinger and open surgical chest drain insertion are discussed.