What are possible complications of tension pneumothorax?

Updated: Apr 28, 2020
  • Author: Brian J Daley, MD, MBA, FACS, FCCP, CNSC; Chief Editor: Mary C Mancini, MD, PhD, MMM  more...
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A worsening pneumothorax, usually with a 1-way valve phenomenon, can allow air into the intrapleural space and prevent its escape, causing mediastinal shift, pulmonary shunting, and circulatory collapse.

Treatment of tension pneumothorax is emergent and should be performed before confirmatory radiologic studies. Needle decompression is performed before definitive treatment with tube thoracostomy (see Tension pneumothorax under Hospital Management).

In mechanically ventilated patients, high pressures and air trapping place patients at risk for tension pneumothorax if the thoracostomy is not functioning. Patients with smaller pneumothoraces that would otherwise be managed with aspiration or observation sometimes undergo thoracostomy because of the need for mechanical ventilation.

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