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1 Source and Characteristics of Included Case Reports/Series of Patients with Tension Pneumothorax Stratified by Patient Ventilatory Status. Source, Year No. Case Characteristics of the Included Case Reports/Series Patients Cases No. Age/ Ventilatory Status/ Reported Past Etiology/Side of Reported Present Satisfied InclGender Setting Tension History Tension PTX History or Published uded PTX Potentially Tension Encountered* Confounding PTX Definition† Factors Breathing unassisted case reports (n=86)‡ Veno and 1 1 67/M Breathing NR Rupture of lower Gastric contents in Yes Eckardt, 20131 unassisted/ED esophagus secondary pleural cavity and to Boerhaave’s empyema syndrome from Norovirus-induced forceful emesis/left Tagami et al., 1 2 69/M Breathing No relevant past Acupuncture/bilateral Yes 20132 unassisted/ED medical history Pourmand et 1 3 84/F Breathing Two previous rectal Colonoscopy-related Yes al., 20133 unassisted/ED surgeries and a pneumoperitoneum hemorrhoidectomy (hypothesized by authors to be secondary to leakage of air from a previous rectal anastomosis)/right Yekeler et al., 1 4 26/M Breathing Previously Blunt trauma and No 20124 unassisted/ED undiagnosed ruptured pulmonary pulmonary hydatid hydatid cyst/left cyst Spindelboeck 1 5 65/F Breathing End-stage COPD on Secondary Yes and Moser, unassisted/ICU home oxygen therapy spontaneous/left 20125 Hifumi et al., 1 6 51/M Breathing Atrial fibrillation, Primary Type A aortic No 20126 unassisted/ED smoking (one packspontaneous/left dissection per-day for unknown duration), and retinal detachment Riwoe and 1 7 31/F Breathing Smoking Primary No 2 Poncia, 20117 Punn and Seslar, 20118 unassisted/ED Breathing unassisted/inhospital (location unclear) Breathing unassisted/GI endoscopy suite Systemic lupus erythematosus spontaneous/left Unclear/left 1 8 14/F Al-Ashaal et al., 20119 1 9 25/F Saks et al., 201010 1 10 46/M Breathing unassisted/ED Paul et al., 201011 1 11 68/M Breathing unassisted/prehospit al Hippargi, 201012 1 12 25/M Breathing unassisted/ED NR Blunt trauma/right Hellings et al., 201013 1 13 55/M Breathing unassisted/hospital ward Alcoholism and pancreatitis Occlusion of the wall suction unit resulting in thoracostomy tube suction failure/right NR Treated TB and recent alcohol and crack cocaine use NR Renal failure, ascites, neutropenia, and thrombocytopenia No ERCP-related retropertioneal duodenal perforation/left Penetrating trauma/right Referred for cholecystitis and common bile duct obstruction No Blunt trauma (injured by bull)/left Other injuries included rib fractures, left flail chest, massive hemothorax, and pelvic fracture; underwent thoracotomy for apical lung rupture and a negative exploratory laparotomy Injuries included rib fractures, multiple contralateral pulmonary contusions, and a large tear involving the right mainstem bronchus Admitted for upper GI hemorrhage requiring resuscitative thoracotomy with cross-clamping of the No No No No 3 Wegener’s granulomatosis, nonhealing lower extremity venous ulcers, and severe malnutrition NR Freeberg et al., 201014 1 14 59/F Breathing unassisted/ICU Ben-Chetrit and Merin, 201015 Athey and Hills, 201016 Song et al., 200917 1 15 19/M 1 16 43/M 1 17 78/F Breathing unassisted/ED Breathing unassisted/ED Breathing unassisted/ED Ekim and Ekim, 200918 1 18 21/F Breathing unassisted/ED Pulmonary hydatid cyst Caceres et al., 200919 1 19 41/M Breathing unassisted/hospital ward Hepatitis C, chronic pain secondary to tibial osteomyelitis, trauma to the lumbar spine and lower extremities, chronic oral narcotic and benzodiazepine use, and intravenous use of self-administered, crushed oral methadone resulting in talc-induced Pulmonary TB NR Inadvertent right mainstem bronchus perforation during narrow-bore enteral feeding tube insertion/right Primary spontaneous/right Secondary spontaneous/left ERCP-related retroperitoneal perforation/right Secondary spontaneous (ruptured hydatid cyst)/left Secondary spontaneous/left aorta and laparotomy with gastrectomy; postoperative course complicated by spontaneous PTX and bronchopleural fistula Necrotizing pneumonia, cytomegalovirus viremia, and bilateral lower extremity DVT Yes Yes No Referred for cholelithiasis, cholecystitis, and choledocholithiasis No No No 4 Patterson et al., 200820 Finch and Pittman, 200821 1 20 35/M Breathing unassisted/ED Breathing unassisted/ED 1 21 76/M Zahoor et al., 200722 1 22 60/F Breathing unassisted postGA/OR Wachsman et al., 200723 1 23 67/F Breathing unassisted/hospital ward Leigh-Smith and Christey, 200624 Howells and Green, 200625 1 24 16/M Breathing unassisted/ED 1 25 66/M Breathing unassisted while receiving spinal pulmonary granulomatosis NR Benign right lung mass, smoking (90 pack-year history), asthma, COPD with multiple pleural blebs throughout the right lung field, CAD, and home oxygen therapy Cholelithiasis, biliary colic, and hypertension treated with enalapril 5 mg daily (ASA class II) Primary spontaneous/left Secondary spontaneous/right Barotrauma (intermittent PPV during GA with bucking on the ETT after surgery)/right Yes Multiple right apical pleural blebs No Recently postoperative from cholecystectomy under GA with use of nitrous oxide; anesthetic reversal with neostigmine and atropine Yes Stage IV non-small cell lung CA with intraparenchymal metastases, advanced carcinomatosis, bilateral malignant pleural effusions (indwelling left-sided tunneled pleural catheter), and home oxygen therapy Asthma Pigtal thoracostomy tube insertion for pleural effusion drainage/right Yes Secondary spontaneous/right Yes CAD, HTN, MI, 3vessel CABG, smoking (50 year Unclear/left Presented for skin grafting to shin and found to have Yes 5 anesthesia in the sitting position/OR history), and femerodistal bypass grafting Ball et al., 200626 1 26 77/F Breathing unassisted/GI endoscopy suite Appendiceal CA managed with right hemicolectomy and iron deficiency anemia Colonoscopy-related perforation of a preexisting ileocolic anastomosis/bilateral Williams and Laing, 200527 1 27 19/F Breathing unassisted/hospital ward Cystic fibrosis with advanced lung disease Subotich and Mandarich, 200528 Soundappan et al., 200529 McRoberts et al., 200530 1 28 32/M NR 1 29 12/M 1 30 47/M Breathing unassisted/hospital ward Breathing unassisted/ED Breathing unassisted/ED Attempted blood patch pleurodesis of a persistent right PTX, which resulted in indwelling thoracostomy tube obstruction/right Reversal of air flow in chest tube aspiration system/left Blunt trauma/right Asthma Epilepsy treated with phenytoin; heavy alcohol consumption on day of presentation Blunt trauma (fall 6 m onto grass from a second floor apartment)/right occlusion of femerodistal bypass graft; subsequently underwent a redo femerodistal bpass graft under GA, debridement of left shin under spinal anesthesia, and then skin grafting of left shin under spinal anesthetic, during which a tension PTX developed Colonoscopy-related perforation of a previously created ileocolic anastomosis with associated peritonitis Right secondary spontaneous PTX treated with tube thoracostomy No No Yes Apical pleural bullae Yes Other injuries included pulmonary contusion, multiple rib fractures, hemothorax, left No 6 pubic rami fractures, right facial fracture, and liver contusion Underwent laparoscopic converted to open cholecystectomy; prior to PACU admission was MV with TV 500 mL and PIP 26-33 cm H2O Chen et al., 200531 1 31 71/F Breathing spontaneously through an ET tube and T-piece device without positive airway pressure/PACU HTN, cardiomegaly, heart failure, atrial fibrillation (preoperative ventricular response rate 130-140), and cholelithiasis Barotrauma/left Peuker, 200432 1 32 38/F Past medical history unremarkable Acupuncture/left No Brims, 200433 1 33 23/M Smoking Primary spontaneous/left Yes Rawlins et al., 200334 2 34 27/M NR Unclear/right No 35 27/M Breathing unassisted/prehospit al Breathing unassisted/prehospit al Breathing unassisted/ED Breathing unassisted/ED Breathing unassisted/prehospit al NR Unclear/left No NR Blunt trauma (fall three stories into a domestic lift shaft)/left Breathing unassisted/ED Breathing unassisted/ED Breathing unassisted/ED NR Blunt trauma/left Yes NR Unclear/left Yes COPD and obesity Secondary spontaneous/right Yes Leigh-Smith and Davies, 200335 1 36 14/M Jones and Hollingsworth, 200236 3 37 18/M 38 35/F 39 58/M Other injuries included left hemothorax, pulmonary contusion, and pubic ramus fracture; ruptured spleen (managed with splenectomy); and stable lumbar spine fracture Yes Yes 7 Allison et al., 200237 2 40 17/M 41 13/M Breathing unassisted/prehospit al Breathing unassisted/prehospit al Breathing unassisted/inhospital (location unclear) NR Blunt trauma/left No NR Blunt trauma (MVC)/left Yes NR Prolonged group A Streptococcus pyogenes pharyngitis with extension to cervical soft tissue, upper mediastinum, and pleura/left Secondary spontaneous/right No Khatib and Siwik, 200038 1 42 20/F Holloway and Harris, 200039 4 43 22/F Breathing unassisted/ED Asthma 44 19/M NR 45 20/F Breathing unassisted/ED Breathing unassisted/ED 46 45/M Breathing unassisted/ED Breathing unassisted/hospital ward Breathing unassisted/prehospit al NR Harten et al., 200040 1 47 37/F Friend, 2000 41 1 48 20/F NR Smoking (20 cigarettes per day for unknown duration) Bilateral subpleural blebs and recurrent spontaneous pneumothoraces, including need for prior resection of a Primary spontaneous/left Primary spontaneous/right Primary spontaneous/left Barotrauma/right Primary spontaneous/right Apical pleural bullae found during subsequent thoracotomy No No Long-standing apical pleural adhesions, which bled as the lung collapsed, resulting in concomitant hemothorax Yes Yes Postoperative 8 hours after emergency caserean section Yes Yes 8 Tan and van der Vliet, 199942 1 49 36/F Breathing unassisted/hospital ward Strizik and Forman, 199943 1 50 82/F Breathing unassisted/ED Rigg and Walker, 199944 1 51 69/M Breathing unassisted/hospital ward Onyeka and Booth, 199945 1 52 72/F Kannan et al., 199946 1 53 Ho, 199947 1 Crocker and Ruffin, 199848 1 ruptured apical pleural bleb Ulcerative colitis Subclavian vein access needle puncture/right Diverticular bleeding and smoking (80 pack-year history) Osteoarthritis Unclear/left Breathing unassisted/ED NR Boerhaave’s syndrome/right 77/F Breathing unassisted/ICU Diabetes Tracheal injury during use of nasogastric tube forceps for difficult nasogastric tube insertion/right 54 73/M Breathing unassisted/ICU NR Transbronchial placement of a finebore feeding tube/right 55 57/M Breathing unassisted/hospital ward COPD Insertion of a drinking straw through the exit aperture of the Ruptured lower esophageal (epiphrenic) diverticulum/right Admitted for subtotal colectomy and creation of an ileoanal pouch No No Also developed a concomitant generalized erythematous rash, dyspnea, and hypotension; was postoperative after a Charnley arthroplasty Boerhaave’s syndrome from lower third esophageal rupture Recovering from severe diabetic ketoacidosis and above the knee amputation for lower limb thromboembolism Nosocomial pneumonia after urgent hemicolectomy for obstructing colon CA No No No No Yes 9 Heimlich flutter valve, folding the flutter valve back on itself and resulting in closure of the drainage system/left Blunt trauma (MVC)/right Bailey and Esberg, 199849 1 56 50/M Breathing unassisted/ED NR Vermeulen et al., 199750 1 57 56/M Breathing unassisted/ED NR Blunt trauma (jump off of a three-story building)/left Morley et al., 199751 1 58 80/F Breathing unassisted/GI endoscopy suite NR Bjerre, 199752 1 59 44/F Breathing unassisted/inhospital (location unclear) Facet syndrome ERCP-related intraperitoneal duodenal perforation/right Intercostal blockade anesthesia for facet syndrome/left Britten and Palmer, 199653 1 60 52/M Breathing unassisted/prehospit al NR Blunt trauma/right Mariani and Sharma, 199454 1 61 44/F Breathing unassisted/ED Pulmonary adenocarcinoma; recent discharge from hospital for persistent PTX managed with Manipulation of modified Heimlich chest drainage system/right Other injuries included multiple right-sided rib fractures and flail chest, a pulmonary contusion, and a hemothorax Other injuries included L1 and L3 vertebral and bilateral dislocated forearm fractures Referred for common bile duct stricture Yes Underwent intercostal blockade anesthesia between ribs 5 and 6 on the left Other injuries included right rib fractures and pulmonary contusions No No No Yes Yes 10 Hollins et al., 199455 2 62 25/M Breathing unassisted/ED 63 37/M Breathing unassisted/ED Hemilich valve thoracostomy tube drainage and sclerotherapy No previous medical history and on no medications Unspecified lung damage following an episode of decompression sickness 8 years previously and childhood asthma NR Primary spontaneous/right No Secondary spontaneous/left No Katz and Groskin, 199356 1 64 27/F Breathing unassisted/ED Wilkinson et al., 199257 1 65 48/M Breathing unassisted/prehospit al NR Blunt trauma (skiing)/right Spouge and Thomas, 199258 1 66 57/M Breathing unassisted/inhospital (location unclear) Pulmonary nodule Reversal of Hemilich valve attached to indwelling thoracostomy tube/right Cook et al., 199259 Smolle-Juettner 1 67 16/F LUL bronchial atresia 2 68 21/M Breathing unassisted/ED Breathing Secondary spontaneous/left Unclear/right NR Blunt trauma (MVC)/right Massive hemothorax secondary to PA laceration after tension PTX diagnosis Other injuries included rib fracture and greenstick fracture of right clavicle 9 F tube thoracostomy catheter attached to a Heimlich drainage valve with a standard trumpet/luer lock connecting tube placed after CTguided biopsy of pulmonary nodule No Yes No No Chest pain, cough, No 11 et al., 199160 unassisted/ED 69 40/F and dyspnea on exertion for 4 weeks prior to presentation Breathing unassisted/ED Breathing unassisted/ED NR Unclear/right NR Blunt trauma/left Inadvertent placement of a nasogastric tube through the right mainstem bronchus and into the pleural space/right Primary spontaneous/left McCall et al., 198661 1 70 24/M Gough and Rust, 198662 1 71 83/F Breathing unassisted/ED NR Werne and Sands, 198563 1 72 50/M Breathing unassisted/ED Askins, 198464 1 73 41/F Sandor and Tolas, 198265 1 74 28/M Breathing unassisted/ED Breathing unassisted/OR Smoking (30 packyear history) and HTN treated with chlorthalidone 50 mg daily and chlordiazepoxide 25 mg twice daily Smoking (7.5 packyear) Past medical history unremarkable Slay et al., 197966 Forester, 197967 1 75 52/M 1 76 55/M Breathing unassisted/ED Breathing Emphysema and bilateral pleural blebs Congential pleural Primary spontaneous/left Primary spontaneous (possibly secondary to post-anesthetic coughing episode)/right Secondary spontaneous/right Primary No Other injuries included communited T7-T9 vertebral fractures and pneumocephalus Ingestion of 250 tablets of calcium vitamin and 16 ounces of Witch Hazel (ethyl alcohol) as a suicide attempt No No No No Recently postoperative after removal of an impacted mandibular molar under GA with use of nitrous oxide (was spontaneously breathing throughout) No No Yes 12 unassisted/ED blebs and spontaneous pneumothoraces NR spontaneous/left Secondary spontaneous (ruptured hydatid cyst)/left Subclavian vein access needle puncture/left Nayak and Lawrence, 197668 Balikian et al., 197469 1 77 73/F Breathing unassisted/ED 1 78 25/F Breathing unassisted/ED Pulmonary hydatid cyst Fuzzey, 197070 1 79 30/F Breathing unassisted/ angiography suite Asthma and epilepsy Patton et al., 196971 1 80 53/M Advanced pulmonary sarcoidosis Liver biopsy/right No Bakir and AlOmeri, 196972 5 81 12/M Pulmonary hydatid cyst 26/F 83 40/F 84 33/F 85 18/F Secondary spontaneous (ruptured hydatid cyst)/right Secondary spontaneous (ruptured hydatid cyst)/right Secondary spontaneous (ruptured hydatid cyst)/left Secondary spontaneous (ruptured hydatid cyst)/left Secondary spontaneous (ruptured hydatid Yes 82 Breathing unassisted/inhospital (location unclear) Breathing unassisted/inhospital (location unclear) Breathing unassisted/inhospital (location unclear) Breathing unassisted/inhospital (location unclear) Breathing unassisted/inhospital (location unclear) Breathing unassisted/hospital ward Pulmonary hydatid cyst; otherwise healthy Pulmonary hydatid cyst Pulmonary hydatid cyst Pulmonary hydatid cyst Perforated gastric ulcer/right Presented with perforated gastric ulcer No No Recently extubated after having received GA with use of nitrous oxide Suspected rib fracture Yes No No No No 13 Vance, 196873 1 86 36/F Assisted ventilation case reports (n=97) Gupta and 1 1 64/F Modrykamien, 201374 Breathing unassisted/hospital ward Smoking (60 cigarettes per day for an unknown duration) and chronic bronchitis Tracheostomy and manual ventilation/PACU Diabetes; total colectomy for diverticulitis complicated by abdominal wall infection, sepsis, and respiratory failure requiring tracheostomy; and two prior ventral hernia repairs NR Garmon et al., 201375 1 2 23/F ET intubation and MV/GI endoscopy suite ET intubation and MV/OR Wildgruber and Rummeny, 201276 Son et al., 201277 1 3 24/F 1 4 53/F ET intubation and MV/OR Rashid et al., 201278 1 5 74/F Manual jet ventilation through an airway exchange catheter situated in the ET tube/OR Shetty et al., 201179 1 6 40/M ET intubation and MV/ICU NR Kyphoscoliosis secondary to spinal TB at 20 years of age HTN, CAD, aortic and tricuspid valve disease (and prior mitral valve repair), diastolic heart failure, possible COPD, large thyroid mass, and obesity NR cyst)/left Secondary spontaneous/right Pregnancy, small right simple PTX, and painless vaginal bleeding Yes Iatrogenic posterior tracheal wall laceration during tracheostomy/unclear Admitted for third ventral hernia repair, which was complicated by respiratory failure requiring repeat tracheostomy No ERCP-related duodenal perforation/bilateral Unclear/bilateral Referred for cholelithiasis and choledocholithiasis Undergoing bilateral augmentation mammoplasty Yes Internal jugular vein access needle puncture/right Barotrauma/left Blunt trauma/bilateral No Yes Hemorrhagic stroke secondary to ruptured cerebral aneurysm Yes Blunt tracheal injury No 14 Seat and Sim, 201180 1 7 41/M ET intubation and MV/ICU NR Blunt trauma/left Roberts et al., 201181 1 8 46/M ET intubation and MV/ED NR Blunt trauma (MVC)/left Du and Zuo, 201182 1 9 76/M ET intubation and manual ventilation/PACU Mild obstructive airways disease Freeberg et al., 201014 1 10 86/F ET intubation and MV/ICU Alzheimer’s disease and previous stroke Barotrauma (presumed secondary to forceful coughing and severe bucking on the ET tube)/left Inadvertent right mainstem bronchus perforation during narrow-bore enteral feeding tube insertion/right Houtman et al., 200983 1 11 70/F ET intubation and VCV (TV 400 mL, PIP 15 cm H2O, PEEP 5 cm H2O, and mean airway HTN; medications included candesartan and lorazepam Barotrauma (tension PTX hypothesized by authors to be secondary to a left main bronchus ball- Injuries included rib fractures, flail chest, pulmonary contusions, right hemothorax, and left pneumothorax (bilateral chest tubes placed prior to ET intubation) Other injuries included bilateral rib fractures, a large left flail chest segment, pulmonary contusions, and a grade II splenic laceration (treated with splenectomy) Yes Yes Yes Hemorrhagic shock, acute kidney injury, and severe electrolyte disturbances requiring hemodialysis secondary to hematemesis/upper GI hemorrhage Consumption of alcohol prior to presentation and macroaspiration of food while No Yes 15 pressure 15 cm H2O)/ED valve obstruction from an aspirated piece of food)/left Chan et al., 200984 1 12 86/M MV/ICU NR Unclear/left Zugliani et al., 200885 1 13 16/F ET intubation and MV/OR ASA class I Perraut et al., 200886 1 14 67/F ET intubation and MV (TV 600 mL, PEEP 5 cm H2O)/ED Emphysema Barotrauma (presumed secondary to a kink in the tubing connecting the lower aspect of the canister on the anesthetic machine to the device itself, blocking the flow of gases)/bilateral Blunt trauma/left intoxicated resulting in a peiece of food occluding the proximal left bronchus Bedridden male admitted for aspiratoin pneumothorax complicated by acute respiratory failure requiring MV Receiving GA for corneal conjunctival covering Concomitant injuries included rib fractures; along with tension PTX, also developed massive subcutaneous emphysema, which obstructed movement of the chest wall bilaterally; given 0.5 mg of 1:1000 subcutaneous epinephrine followed later by an IV epinephrine infusion Yes No Yes 16 Nunn et al., 200787 1 15 55/M Jet ventilation via an airway exchange catheter placed through a surgically-created tracheostomy stoma (with short insufflation bursts given from a 50 psi pressure source)/OR HTN, atrial fibrillation, COPD, and smoking Barotrauma/bilateral Huang et al., 200588 1 16 34/M Double- and then single-lumen ET intubation with manual ventilation/OR Asthma and two prior spontaneous PTXs (one of which was treated via thoracotomy) Chen et al., 200531 1 17 40/M ET intubation and MV/OR NR Barotrauma (inappropriately small double-lumen ET tube that was inserted too far and delivered most of the PPV to the left lung)/left Blunt trauma (MVC)/left Mega et al., 200489 1 18 34/M ET intubation and maintenance of MV via a “ventilatory prosthesis” (TV 750 mL)/PACU ASA class IE Penetrating trauma/right Underwent urgent resection of partially obstructing 5 cm tracheal mass 4 cm proximal to the carina; surgery complicated by tracheomalacia distal to the surgical anastomosis and left mainstem bronchomalacia Admitted with a right-sided simple PTX treated with tube thoracostomy (indwelling at the time of onset of the left tension PTX) Yes Right rib fractures and hemopneumothorax and left hemopneumothorax already treated with tube thoracostomy prior to PPV Other injuries included GSWs to the left submandibular and right inguinal regions, with bullet lodged in infrahepatic fat; described to be in hypovolemic shock after diagnosis of Yes Yes No 17 Gordon et al., 200490 1 19 19/F ET intubation and MV (TV 550-650 mL, PIP 37-42 cm H2O, and PEEP 5 cm H2O) followed by manual ventilation via an Ambu bag/PACU NR Barotrauma or unrecognized pneumothorax after blunt trauma with institution of PPV in OR/left Behnia and Garrett, 200491 1 20 46/F ET intubation and “aggressive manual ventilation” after a period of MV/ICU Barotrauma/unclear Gambrill, 200292 1 21 80/F ET intubation with jet ventilation (driving pressure 20-25 cm H2O) followed by mechanical (8 mL/kg TV and PIP 23-36 cm H2O) and then “aggressive manual ventilation”/OR Janssens et al., 200093 1 22 75/F ET intubation and MV/ICU Emphysema, HTN, and migraines (outpatient medications included aspirin, butalbital, caffeine, and laxatives) Subglottic stenosis and stridor secondary to tracheostomy performed for prolonged ventilatory support after a 3vessel CABG; also HTN, CAD, angina, moderate AI, type 2 diabetes, OSA, hypothyroidism, and hiatal hernia (described as ASA class III) COPD; no CAD history Unclear/right Subclavian vein access needle tension PTX Other injuries included right rib fractures and pulmonary contusions, and a right hemoPTX (treated with two tube thoracotomies), grade III liver laceration, and pelvic fracture; underwent GA with use of nitrous oxide for ORIF of pelvis Already fitted with a small bore (<14 F) tube thoracostomy and Heimlich valve in the hemithorax in which the tension PTX later developed Admitted to undergo tracheal dilation; given metoprolol 5 mg to maintain HR between 80 and 90 Treatment for an acute exacerbation of No No Yes Yes 18 puncture/right Hardy et al., 200094 1 23 52/F Engoren and de St. Victor, 200095 2 24 16/M 25 16/M 26 19/M Kirkpatrick et al., 200996 1 Jet ventilation via an 8-inch copper stylet (insufflation pressures 28-30 psi)/OR Manual ventilation through a cricothyroidotomy and right mainstem bronchus intubation with an ET tube (6.0 mm internal diameter)/ED Manual or mechanical ventilation through a cricothyroidotomy and right mainstem bronchus intubation with an ET tube (6.0 mm internal diameter)/ED ET intubation and MV/ED COPD in a nursing home prior to admission was complicated by severe hypoxia and ventricular fibrillation (was successfully resuscitated into a perfusing rhythm before ICU admission) Undergoing direct microlaryngoscopy Smoking (60 packyear history), chronic bronchitis, cervical fusion, and vocal cord polyps NR Barotrauma/bilateral Yes Barotrauma/right Severe craniofacial injuries Yes NR Barotrauma/right Right clavicle frature and pulmonary contusion as well as a ruptured spleen requiring splenectomy No NR Blunt trauma (MVC)/right Also sustained a closed head injury Yes 19 Ibrahim et al., 199997 1 27 58/M ET intubation and MV (TV 1000 mL and PIP 36 cm H2O)/OR Infected, necrotizing pancreatitia with MRSA growing in pancreatic fluid and blood Barotrauma/left Baraka, 199998 1 28 45/M Jet ventilation via a Cook airway exchange catheter situated in the ET tube (1 sec burts from a 50 psi pressure source)/OR No history of cardiopulmonary disease Barotrauma/right CampbellSmith et al., 199899 1 29 34/F ET intubation and intermittent PPV/ED NR Silbergleit et al., 1996100 1 30 61/F ET intubation with the ET tube attached to a selfinflating bag-valve device/CT scanner in Diagnostic Imaging Department NR Blunt trauma (crush injury to chest secondary to horse falling on patient’s chest twice during a horse jumping accident)/left Barotrauma (occlusion of the bleed on the reservoir of a bag-valve device)/left Wells and Aves, 1995101 1 31 51/F ET intubation and MV (TV 620-670 mL and PIP 25-27 cm H2O)/OR NR Subclavian vein access needle puncture/right Tension PTX complicated by systemic air embolism, likely secondary to a bronchovenous fistula Scheduled for laparoscopic cholecystectomy Yes Other injuries included multiple bilateral rib fractures, a hemothorax, and a left pulmonary contusion No Pedestrian versus motor vehicle; presented with a GCS score of 12, a right parietal skull fracture and acute epidural hematoma, and tibiafibula and forearm deformities Aneurysmal SAH requiring GA (including use of nitrous oxide) and craniotomy for Yes Yes Yes 20 Plewa et al., 1995102 1 32 57/F ET intubation and MV (TV 600 mL on average and PEEP 3 cm H2O)/PACU Paraplegia, bilateral ischial pressure ulcers, and an ileal conduct for urinary diversion Subclavian vein access needle puncture/left McConaghy and Kennedy, 1995103 1 33 20/F ET intubation and MV (PIP 30 cm H2O)/ED NR Blunt trauma (run over by a motor vehicle several times)/right Kaye et al., 1995104 1 34 32/F ET intubation and MV (PIP 23 cm H2O)/OR Smoking (10 packyear history) Chan and Manninen, 1995105 1 35 54/F Rheumatoid arthritis (managed with oral aspirin, naprosyn, and prednisone, as well as gold injections) and history of atlantoaxial subluxation and basilar invagination Baldwin, 1995106 1 36 56/M Exchange of a nasotracheallyplaced ET tube through use of a jet ventilation catheter using a Sandor-type injector (50 psi pressure source)/OR ET intubation and MV/ICU Local anesthetic infiltration into the breasts with a spinal needle during bilateral breast augmentation/left Barotrauma/right Loer and Fritz, 1 37 60/F Double lumen Esophageal CA NR Subclavian vein access needle puncture/right Subclavian vein clipping of an intracranial aneurysm Subclavian CVC inserted 10 d prior to undergoing laparotomy and repair of parastomal hernia for small bowel obstruction under GA Injuries included a right PTX; first rib, bilateral humeri, pubic symphysis, and right femur fractures; a dislocated steroclavicular joint; and a closed head injury Receiving GA, including use of nitrous oxide Yes Yes Yes Admitted to undergo transoral decompression and occipitocervical fusion under GA No Esophagectomy complicated by sepsis Yes CVC insertion- Yes 21 1994107 intubation and MV (PIP 19 cm H2O)/OR access needle puncture/left Katz et al., 1994108 1 38 33/M ET intubation and PPV/ED NR Blunt trauma (MVC)/right Beards and Lipman, 1994109 3 39 33/F ET intubation and MV with PCV (pressure 30 cm H2O and PEEP 10 cm H2O)/ICU NR Barotrauma/left 40 46/M ET intubation and MV with PCV (pressure 25 cm H2O PEEP 8 cm H2O)/ICU NR Subclavian vein access needle puncture/left 41 53/M ET intubation and NR Blunt trauma/bilateral related PTX treated with a Buelau drain and suction preoperatively Other injuries included multiple rib fractures, T5-T9 thoracic spinal fractures, and pneumocephalus Underwent laparotomy for colpotomy and then later re-laparotomy for removal of ovary and fallopian tube for left-sided tuboovarian abscess that ruptured into the pouch of Douglas; postoperative course complicated by sepsis requiring dobutamine to maintain MAP >80 mmHg and ARDS Plasmodium falciparum malaria, ARDS, and a simple pneumothorax secondary to subclavian CVC insertion 3 days prior to onset of tension PTX, which was treated with tube thoracostomy Other injuries No Yes Yes Yes 22 MV with PCV (pressure 36 cm H2O and PEEP 10 cm H2O)/ICU Mines and Abbuhl, 1993110 1 42 68/M McEwan et al., 1993111 1 43 63/F Connolly, 1993112 1 44 Cohen and Laker, 1993113 1 45 included multiple rib fractures, flail chest, degloving injury of right calf, and a C7 vertebrae transverse process fracture; underwent a negative trauma laparotomy after admission ET intubation and manual or mechanical ventilation/ED ET intubation and MV/OR COPD and HTN Barotrauma/bilateral Previous postoperative pulmonary embolism 67/M ET intubation and MV (PIP 28 cm H2O, pressure support 7 cm H2O, and PEEP 3 cm H2O)/ICU COPD and bullous lung disease Barotrauma (blockage of the bacterial filter in the expiratory limb of the anesthetic circuit on the anesthetic machine)/bilateral Barotrauma/right 60/M ET intubation with connection of the oxygen mask tubing to the ET tube, Generally poor health Barotrauma/left Yes Admitted to undergo laparotomy and excision of pelvic mass; GA with use of nitrous oxide Yes Pseudomonas aeruginosa pneumonia and bacteremia complicated by septic shock and DIC; echocardiography after admission revealed no abnormalities of cardiac wall motion or valves with an EF of 65% Cholecystitis; postoperative from exploratory laparotomy for Yes Yes 23 resulting in pressurization of the airways/PACU Russomanno and Brown, 1992114 1 46 60/F ET intubation and MV (TV 600 mL, PIP 15-30 cm H2O, PEEP 0 cm H2O)/ICU ET intubation and MV (PIP 26 cm H2O)/PACU Stage III ovarian CA Barotrauma/right Ruo and Rupani, 1992115 1 47 88/M NR Internal jugular vein access needle puncture/left Reber et al., 1992116 1 48 51/F ET intubation and MV/OR Hypernephroma and smoking (one packper-day) 49 50/F ET intubation and intermittent PPV/OR 50 65/M ET intubation and manual or Sick sinus syndrome with temporary pacemaker insertion advised prior to hysterectomy with bilateral salpingoophorectomy for a fibroid uterus Alcoholic cardiomyopathy and Percutaneous insertion of an intrapleural catheter prior to initiation of surgery for postoperative analgesia/left Subclavian vein access needle puncture/left Panda et al., 2002117 1 Burge, 1992118 1 Tube thoracostomy malposition (tension unresolved lower GI hemorrhage with suspicion of GI perforations Right-sided pneumonia complicated by septic shock Admitted for intertrochanteric femur fracture and found to have concentric LVH, mild aortic sclerosis, and diastolic heart failure; started on nitrates and furosemide prior to GA with use of nitrous oxide Presented for nephrectomy; receiving GA with use of nitrous oxide Yes No Yes Yes Right femur and left rib fractures; treated Yes 24 mechanical ventilation/ED COPD HTN, progressive renal insufficiency, Crohn’s disease, and smoking; treated as an outpatient with oral atenolol and sulfasalazine NR Botz and Brock-Utne, 1992119 1 51 55/M ET intubation and MV (PIP between 14 and 25 cm H2O)/OR Smith et al., 1991120 1 52 25/M ET intubation and MV/OR Mima, 1991121 1 53 NR/NR Mima et al., 1991122 1 54 52/M Laishley and Aps, 1991123 1 55 63/M MV/OR NR ET intubation and volume-limited, time cycled MV (TV 390 mL and PEEP 0 cm H2O)/OR Double-lumen intubation with MV/OR Unremarkable past medical history Right lung adenoCA and mild emphysematous PTX hypothesized by authors to be secondary to air being unable to escape as the tube was situated in the oblique fissure, blocking its drainage holes and creating a valve)/right Barotrauma/left with bilateral tube thoracostomies as patient was anticipated to require PPV Admitted to undergo both vascular access procedure and nephrectomy for left renal mass Yes Barotrauma (obstruction of the bacerial filter on the exhalation side of the breathing circuit on the anesthetic machine)/bilateral Undergoing tangential burn excisions and skin grafting under GA with use of nitrous oxide for 20% TBSA burns to face, axilla, arm, and thigh Yes Internal jugular vein access needle puncture/right Internal jugular vein access needle puncture/right Barotrauma/right No Admitted to undergo hepatectomy (indication not provided) No Yes 25 Kiyama et al., 1991124 1 56 48/M Cronen et al., 1991125 2 57 54/F 58 63/M ET intubation and PPV/PACU Rectal CA ET intubation and MV in SIMV mode (TV 1200 mL, PIP 30 cm H2O, and PEEP 23 cm H2O)/PACU ET intubation and MV and “ventilatory assistance with PEEP”/ICU CAD, angina, MI, and smoking Jet ventilation via an 18 F suction catheter situated in the ET tube and a hand-held device (driving pressure 50 psi)/ICU NR Yu and Lee, 1990126 1 59 54/M Sheffner et al., 1985127 1 60 78/F Egol et al., 1985128 1 61 66/F Jet ventilation via a 14 gauge angiocatheter placed through a tracheostomy incision into the trachea (15 psi pressure source)/OR ET intubation and PPV/OR changes on preoperative CXR Papillary thyroid CA requiring right thyroid lobectomy and three subsequent resections of locally recurrent disease complicated by tracheal stenosis Inflammatory bowel disease Mitral valve disease, HTN, and heart failure Barotrauma/bilateral Yes Subclavian vein access needle puncture/left Subclavian vein access needle puncture/right Unclear/right Receiving GA for laparotomy and bowel resection Admitted to undergo abdominoperineal resection Postoperative from CABG; on nitroglycerin and dopamine infusions Yes Iatrogenic creation of a bronchopleural fistula during insertion of a soft feeding tube with an indwelling wire stylet/right Barotrauma/right Presented with pulmonary edema and then developed ARDS No Thoracic spine fusion for osteoporotic compression fractures complicated by postoperative retroperitoneal hematoma, Yes Yes Yes 26 Bekemeyer and Zimmerman, 1985129 1 62 18/M Right mainstem bronchus intubation and PPV/in-hospital (location unclear) ET intubation and MV (PEEP 10 cm H2O)/ICU Previously well Secondary spontaneous/left Woodcock et al., 1984130 1 63 21/M NR Subclavian vein access needle puncture/left Edwards, 1984131 3 Pyles et al., 1983132 2 64 65 66 67 NR/NR NR/NR NR/NR 68/F MV/ICU MV/ICU MV/ICU ET intubation and MV/OR NR NR NR NR 16/F ET intubation and MV/OR No medical problems Barotrauma/unclear Barotrauma/unclear Barotrauma/unclear Barotrauma (accidental connection of the ventilator tubing to the ventilatormounted switch valve usually occupied by the reservoir bag on the anesthetic machine)/left Barotrauma (accidental connection of the ventilator tubing to the ventilatormounted switch valve 68 pneumonia, Pseudomonal sepsis, renal failure, and prolonged MV Bacillus cereus pneumonia with massive hemoptysis MVC resulting in multiple right-sided rib fractures, pulmonary contusions, and a hemothorax treated with thoracostomy; subsequent ICU stay complicated by early sepsis and ARDS Receiving GA for repair of a herniated lumbar spinal disc Receiving GA for appendectomy No Yes Yes Yes Yes Yes No 27 Albelda et al., 1983133 1 69 36/M ET intubation and MV (PEEP 7.5 cm H2O)/ICU Alcoholism, diabetes, and seizures Culpepper et al., 1982134 1 70 52/F ET intubation and continuous PPV (PEEP 15 cm H2O)/ICU NR Hubbert et al., 1981135 1 71 17/F ET intubation and MV/OR NR Chang et al., 1980136 1 72 73/F ET intubation and jet ventilation via a 3.5 mm catheter situated in the ET No history of cardiopulmonary disease usually occupied by the reservoir bag on the anesthetic machine)/right Barotrauma (rupture of a subpleural air cyst)/left PA catheter insertion through an indwelling subclavian sheath (authors hypothesized that this produced tension PTX by traversing a parenchymal artery, the contiguous airspace, and the interstitial space with dissection of air through the perivascular sheath and into the tissue planes of the thorax)/bilateral Barotrauma (possibly secondary to obstruction of the ET tube)/bilateral Barotrauma/left Respiratory failure secondary to pneumococcal pneumonia leading to ARDS New onset acute myelogenous leukemia complicated by Staphylococcal pneumonia; developed massive hemoptysis and tension PTX and suffered a PEA arrest after PA catheter inserted Yes Undergoing emergency caserean section; ET tube replaced during case as it was felt to be out of the trachea or occluded Receiving GA for biopsies of recurrent squamous cell CA of tongue Yes No Yes 28 Peatfield et al., 1979137 1 73 19/F Galle et al., 1979138 1 74 19/F McLoud et al., 1978139 2 75 22/F 76 40/M tube (10-16 insufflations/min at a pressure of 15 psi)/OR MV/in-hospital (location unclear) NR Barotrauma and/or blunt trauma from CPR/left ET intubation and MV (TV 700 mL)/OR ET intubation or tracheostomy and MV/ICU Unremarkable past history and pregnancy Paraplegia (T1 level) and progressive kyphosis Unclear/bilateral ET intubation and MV (PEEP 20 cm H2O)/ICU Familial polyposis and colon CA Barotrauma/left Unclear/left Presented with a right simple PTX, which was drained with tube thoracostomy; this was complicated by re-expansion pulmonary edema and cardiac arrest prior to development of tension PTX (bilateral cystic emphysematous bullae found on autopsy) Presented in active labour; GA with use of nitrous oxide Anterior T11-L1 spinal fusion complicated by acute respiratory failure, Serratia respiratory tract infection, Escherichia coli bactermia, ALI/ARDS, and DIC Elective subtotal colectomy and ileoproctostomy complicated by respiratory failure secondary to aspiration pneumonia No No No No 29 Klick et al., 1978140 1 77 81/F ET intubation and ventilation with a hand resuscitator (the Hope® Resuscitator)/PAC U ET intubation and MV (TV 1000 mL, PIP 48-55 cm H2O, and PEEP 6 cm H2O)/ICU NR Barotrauma (inadvertent modification of the hand resuscitator)/unclear Hayes and Lucas, 1976141 2 78 32/M NR Barotrauma/left 79 27/F ET intubation and MV (TV 700 mL, PIP 40-42 cm H2O, and PEEP 5 cm H2O)/ICU Alcoholism Barotrauma/right History and physical examination were “noncontributory” Internal jugular vein access needle puncture/right Cook and Deuker, 1976142 1 80 64/M ET intubation and MV (PIP 35-40 cm H2O)/OR Seher and Janda, 1975143 3 81 34/M Manual hyperventilation after ET intubation/OR Malfunction of tube thoracostomy after repositioning after being initially placed for a simple PTX secondary to a moped and ARDS Postoperative from an 8 h biliary tract operation Bilateral pulmonary infiltrates on CXR (likely ALI/ARDS) after exploratory laparotomy for small bowel obstruction; also diagnosed with severe pancreatitis Admitted for 25% partial back, chest, and arm partial thickness burns; subsequently developed bilateral pulmonary congestion and bronchopneumonia (likely ALI/ARDS) Admitted to undergo exploratory laparotomy under GA, including use of the inhalational agent nitrous oxide Injuries included multiple rib fractures, a simple PTX, and a hemothorax; GA with use of nitrous oxide Yes No Yes Yes Yes 30 82 38/F ET intubation and MV/OR Essential pulmonary haemosiderosis (treated with cortisone therapy for 10 years) 83 35/F ET intubation and PPV/OR Healthy patient Obesity and right lung CA with metastasis to liver Egan and Boutros, 1975144 1 84 62/F ET intubation and MV (TV 10 mL/kg, PIP 50-60 cm H2O, and PEEP 8 cm H2O)/ICU Read et al., 1974145 1 85 48/M ET intubation and MV/OR Laskin and Eatmon, 1974146 1 86 33/M ET intubation and MV/OR NR collision/right Insufficient drainage of traumatic PTX due to small caliber of inserted tube thoracostomy/left Barotrauma (hyperventilation with bag mask and high flow oxygen followed by nitrous oxide)/right Barotrauma/right Barotrauma (erroneous connection of the ventilator to the gas machine, allowing for inflow of gas to the patient, but impeded outflow)/bilateral Blunt trauma (MVC)/right Referred for surgery for spontaneous left PTX secondary to multiple pulmonary parenchymal fistulas; GA with use of nitrous oxide Admitted for Babcock operation due to leg varicosities Yes Bilateral pulmonary airspace disease on chest X-ray with acute respiratory failure requiring ET intubation and MV Admitted to undergo laparotomy for chronic peptic ulceration; GA with use of nitrous oxide Yes Trauma to the face, leg, and chest resulting in a rightsided simple PTX treated with a chest tube that was removed 3 days later (6 days prior to development of Yes Yes Yes 31 Gold and Joseph, 1973147 2 87 52/F ET intubation and MV (PIP 20 cm H2O)/OR Asthma and emphysema Barotrauma/bilateral 88 60/F ET intubation and manual ventilation/OR Barotrauma/bilateral ET intubation and mechanical and manual ventilation (intrapulmonary pressure increased to >50 cm H2O during the operation)/OR ET intubation and MV/OR Smoking for 20 years, COPD with fibrous scarring of both lung apices and pleural thickening of the right costophrenic sulcus, and cecal mass Pulmonary lesion believed secondary to inflammatory fibrosis, chronic bronchitis, asthma, fibromyomata, enlarged uterus, and menorrhagia NR MacKenzie and Patterson, 1971148 1 89 NR/F Dean et al., 1971149 1 90 21/M Rastogi and Wright, 1969150 1 91 63/F ET intubation and intermittent PPV Cholelithiasis, biliary colic, and recent tension PTX) Undergoing anterior vaginal wall repair and a MarshallMarchatti procedure; GA with use of nitrous oxide; gas bubbles found in the left circumflex artery on autopsy secondary to air embolus to right heart Undergoing laparotomy and right hemicolectomy; GA with use of nitrous oxide No Yes Barotrauma/bilateral Undergoing open hysterectomy; GA with use of nitrous oxide Yes Barotrauma (misplaced expiratory valve on the anesthetic machine, resulting in exposure of the airways to high pressures)/bilateral Barotrauma/bilateral Undergoing exploration of left median nerve; GA with use of nitrous oxide Yes Undergoing open cholecystectomy Yes 32 followed by “vigorous” manual ventilation/OR ET intubation and MV/OR respiratory tract infection Alcoholism Subclavian vein access needle puncture/left “Somwhat emphysematous lungs” on preoperative CXR Smoking, emphysema, and subglottic epidermoid carcinoma Barotrauma/left Christian et al., 1969151 1 92 43/M Nennhaus et al., 1967152 1 93 62/M ET intubation and MV/PACU Hamilton and Moyers, 1966153 1 94 50/M Gleave and Monty, 1963154 1 95 48/F Assisted ventilation through an ET tube placed through a distal tracheal stoma during tracheostomy/OR PPV/OR Fairley, 1955155 1 96 20/M ET intubation and MV/OR Dundee, 1955156 1 97 72/F Manual bag mask ventilation/OR under GA with use of nitrous oxide Inhalation burn and 25% TBSA burns to the back, left arm, and legs; underwent GA with use of nitrous oxide for burn wound debridement Postoperative after repair of AAA Yes Unclear/bilateral Undergoing laryngectomy and radical neck dissection; GA with use of nitrous oxide Yes Perforated duodenal ulcer, hysterectomy for fibroids, and pyloric stenosis secondary to duodenal deformity NR Barotrauma/bilateral Pulmonary bullae discovered upon thoracotomy after cardiac arrest Yes Blunt trauma (MVC)/left No Hiatal hernia, GERD, and obesity; described to be “in good condition despite the age of the patient” Manual PPV for 2 min in the setting of a high esophageal tear/unclear Injuries included left femur, tibia-fibula, and clavicle fractures Development of a high esophageal tear after esophagoscopy, for which thoracotomy was scheduled under GA, including use of nitrous oxide No Yes 33 Where AAA indicates abdominal aortic aneurysm; AI, aortic insufficiency; ALI, acute lung injury; ARDS, acute respiratory distress syndrome; ASA, American Society of Anesthesiologists; CA, carcinoma; CABG, coronary artery bypass grafting; CAD, coronary artery disease; COPD, chronic obstructive pulmonary disease; CT, computed tomography; CXR, chest X-ray; CVC, central venous catheter; DIC, disseminated intravascular coagulation; DVT, deep venous thrombosis; ED, Emergency Department; EF, ejection fraction; ERCP, endoscopic retrograde cholangiopancreatography; ET, endotracheal; F, French; GA, general anesthesia; GERD, gastroesophageal reflux disease; GI, gastrointestinal; HR, heart rate; HTN, hypertension; ICU, intensive care unit; IV, intravenous; LUL, left upper lobe; MAP, mean arterial pressure; MI, myocardial infarction; MRSA, methicillin-resistant Staphylococcus aureus; MV, mechanical ventilation; MVC, motor vehicle crash; NR, none or not reported; OR, Operating Room; ORIF, open reduction and internal fixation; OSA, obstructive sleep apnea; PA, pulmonary artery; PACU, Post-Anesthesia Care Unit; PCV, pressure-controlled ventilation; PEEP, positive end-expiratory pressure; PIP, peak inspiratory or airway pressure; PPV, positive pressure ventilation; PTX, pneumothorax; SAH, subarachnoid hemorrhage; SIMV, synchronized, intermittent, mandatory ventilation; TB, tuberculosis; TBSA, total body surface area; TV, tidal volume; and VCV, volume-controlled ventilation. *All pressure quantities converted to units of cm H2O (at 4°C) or psi for patients receiving MV and jet ventilation, respectively. †Determined through consensus after independent assessment by two investigators (κ statistic for agreement=0.89; 95% CI, 0.82-0.95). 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