Successful Chest Tube Removal Following Iatrogenic Pneumothorax in a Patient on Ventilator Support

TL;DR

A 14-year-old girl with iatrogenic pneumothorax had a chest tube removed successfully while on a ventilator, avoiding infection and recurrence.

Contribution

Demonstrates successful chest tube removal in a ventilated patient with iatrogenic pneumothorax without recurrence.

Findings

Chest tube removal was successful without pneumothorax recurrence during ventilator support.

Iatrogenic pneumothorax was confirmed, not due to underlying lung disease.

Balanced clinical judgment and radiographic evidence ensured safe removal.

Abstract

We report the case of a 14-year-old female patient who came from another hospital with complaints of a dry cough for five days, high-grade fever for three days, and altered level of consciousness for the last two days. The patient was found to be in status epilepticus, for which she was planned for intubation. During intubation, the patient was found to have desynchrony with the ventilator, with decreased breath sounds on the right side. A chest X-ray was done, which showed a right-sided pneumothorax for which a chest tube was passed. Due to prolonged hospital stay and recurrent seizures, the patient started to develop fever spikes for which the decision to remove the chest tube was taken while the patient was still on mechanical ventilation, which was successful without the recurrence of pneumothorax. Consideration should be taken that the patient had an iatrogenic pneumothorax during intubation and did not have a pneumothorax due to a lung pathology. This case emphasizes the importance of finding a balance between the timely removal of the patient's chest tube while on mechanical ventilation to prevent it from becoming a source of infection and to avoid the development of another pneumothorax with careful monitoring. The clinician's judgement, along with radiographic evidence and the patient's clinical condition, should always be strongly considered and clinically correlated.

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