Results of Conservative Treatment in Patients With Occult Pneumothorax

Introduction An occult pneumothorax is found in 2%–15% trauma patients. Observation (without tube thoracostomy) in these patients presents still some controversies in the clinical practice. The objective of the study is to evaluate the efficacy and the adverse effects when observation is performed. Methods A retrospective observational study was undertaken in our centre (university hospital level II ). Data were obtained from a database with prospective registration. A total of 1087 trauma patients admitted in the Intensive Care Unit from 2006 to 2013 were included. Results In this period, 126 patients with occult pneumothorax were identified, 73 patients (58%) underwent immediate tube thoracostomy and 53 patients (42%) were observed. Nine patients (12%) failed observation and required tube thoracostomy for pneumothorax progression or haemothorax. No patient developed a tension pneumothorax or experienced another adverse event related to the absence of tube thoracostomy. Of the observed patients 16 were under positive pressure ventilation, in this group 3 patients (19%) failed observation. There were no differences in mortality, hospital length of stay or intensive care length of stay between the observed and non-observed group. Conclusion Observation is a safe treatment in occult pneumothorax, even in pressure positive ventilated patients.