Artificial pneumothorax

The artificial pneumothorax is a method of treatment of pulmonary tuberculosis patients, which consists in the introduction of air in the pleural cavity and providing for the establishment of an air gap (gas bubble) between the pleura for a long period of time.
As a result of artificial pneumothorax elastic reduced voltage of the lung tissue changes lymph and blood flow in a light, creates favorable conditions for healing of TB, in particular, is losing caverns.
Artificial pneumothorax applied with infiltrative and focal tuberculosis of lungs in the phase of decomposition, cavernous pulmonary tuberculosis, as well as in case of absence of the effect after the conducted within 4-6 months. antibiotic therapy. Sometimes artificial pneumothorax is also used in the provision of emergency assistance to stop pulmonary hemorrhage.
Introduction of air in the pleural cavity (wind blowing inside) carry out a special apparatus, which used the principle of communicating vessels. The device consists of two transparent graduated cylinders. Manometer presents a U-shaped tube filled with colored water (the contrast). On character of oscillations of the liquid at the pressure gauge is judged on finding the needle in the pleural cavity (Fig. 1).

the artificial pneumothorax
Fig. 1. The imposition of artificial pneumothorax (scheme). The end of the needle is in the pleural cavity. The pressure gauge shows a negative pressure in the pleural cavity: 1 - pleura; 2 - light; 3 - aperture; 4 - gauge. Fig. 2. Right-artificial pneumothorax. The losing caverns (1) prevent pleural adhesions (2).

For pneumothoraces of the Cabinet is given the bright, warm room. In the office is operating table or hard couch. Introduction of air into the pleura is performed with the patient lying on the healthy side. Under the head of the patient is put a flat pillow under side roller; a hand with a sore hand is laid upon the head, that together with cushion provides maximum expansion of intercostal spaces. In chemist's Cabinet office kept the syringes with needles, sterile material, ampoule with caffeine, kordiamin, injected, 1% solution novokaina, 2% solution of chloral hydrate.
To puncture used needles gauge 2 or 3, it is better platinum, sterilities roasting. Pneumatyczny sterilized the device at least once a month, as recorded in their passport. Metal and glass parts apparatus (cranes, cannula), rubber tubing are sterilized by boiling or in the autoclave. Cleanliness of blown air is provided with a cotton filters, which are changed every 15 days. Removable filter front of the needle changes daily. Before the puncture the skin of the patient treated with alcohol or iodine. During the initial imposition of artificial pneumothorax enter 200-300 ml of air. After the introduction into the pleural cavity every 50-100 ml of air pressure is controlled by a manometer. After removing the needle puncture site is treated with iodine. On the first day of podawania patient is bed-ridden and requires supervision of staff. The primary effect of imposing control radiographically. As the formation of a gas bubble mode patient expanding. The main part of the course, usually on an outpatient basis at a frequency of podawania 1 time in 7-10 days. The duration of treatment artificial pneumothorax is 1.5 years. Termination of pneumothorax is recommended in the hospital or sanatorium.
Sometimes you cannot create effective pneumothorax because of the presence of pleural adhesions (Fig. 2). To eliminate spikes is not always possible, even the method of intrapleural their destruction (burning of adhesions termokamera). In these cases, stop artificial pneumothorax and apply other methods of surgical treatment of tuberculosis.

The artificial pneumothorax is one of the methods of colapsoterapiei, which consists in the introduction of air in the pleural cavity. Used in the treatment of tuberculosis (mostly in fresh destructive forms).
Clinical artificial pneumothorax proposed Forlanini (C. Forlanini, 1882).
Despite the successful application currently antibacterial chemotherapy, artificial pneumothorax is still adopted by clinic, although indications for treatment has changed (see below). Apply unilateral and bilateral P. I.
After artificial education intrapleural air bubble with preservation of the negative pressure in the pleural cavity is gradually losing light due to the election of elasticity (Fig. 1) and contractile peculiar light (F. A. Mikhailov). First of all zadayutsya affected areas of the lung; healthy segments, retaining the elasticity remain in the conditions of negative intrapleural pressure is relatively straightened, air. However easy when artificial pneumothorax exposed relative immobilization, reduced respiratory volume fluctuations of light, i.e. the body put in terms of the relative functional peace. Electoral losing light accompanies lymphostasis. Therefore limited to the scattering of Mycobacterium tuberculosis and stimulated the development of connective tissue. Thus, increase of reparative processes, and in sections destruction exudative changes dissolve and give way to the fibroid. While there has been a gradual losing and healing caverns. There cicatricial changes in lesions, and in collaborating perifocal zone.
In counteractively period to achieve full clinical therapeutic effect P. I. demanded 2-3 years or more. Now, when the treatment of P. I. combined with chemotherapy, this period was reduced to 1,5-2 years. In addition, complications P. I. pneumophilia are less common.

Methods and equipment. The apparatus for artificial pneumothorax consists of two connected and moving one in relation to other vessels, one of which is filled with air for introduction into the pleural slit. Gas is injected through platinum needle under the control of water gauge included in the design of the device (Fig. 2).
Primary imposition P. I. produced in compliance with their operating environment. Patient is placed on the healthy side and choose the operating
field taking into account the location of the lesion (out of it). Puncture the chest wall is produced in the corresponding intercostal space, often in IV or V, between the axillary lines. During the implementation of the tip of the needle in the pleural the crack on the manometer arise expressed fluctuations reflecting fluctuations intrapleural negative pressure, slowly allowing to enter the gas initially under the suction effect of light (Fig. 3). During the initial imposition P. I. enter 200-300 ml of gas. After each 50 or 100 ml of the gas pressure is controlled by a manometer. The primary effect of imposing control radiographically. The next day the introduction of gas again. Then podawania done in a day, after 2 to 3 days, and finally, after 10 days and more under radiological control of the pace and quality of spadenia easy and considering the readings of manometer. Optimal (therapeutically effective) size of the gas bubble support for 1-2 years.
Indications and contraindications to the imposition of artificial pneumothorax has changed, because a significant number of patients cured currently using chemotherapy in terms of the applicable hygienic and diet regime.
However therapeutic pneumothorax shown effective for some fresh infiltrative processes of nature with the collapse, radiographically defined or bacteriologically confirmed (Mycobacterium tuberculosis in sputum); with limited disseminated with infiltrative layers and decay; when expressed cavernous lesions without significant fibrosis and participation of the pleura (Fig. 4), and in order emergency pulmonary hemoptysis and bleeding when installed their source.
Contraindications: common fibro-cavernous and cirrhotic of the lungs, especially when events pulmonary-cardiac insufficiency; directly podplavlenie location caverns; generalized forms of tuberculosis with other organs (intestines, kidneys and so on); phenomena of cachexia.
Treatment of pulmonary tuberculosis usually start with antibacterial therapy, and only if for 4-6 months. no positive results, one should resort to artificial pneumothorax, while continuing chemotherapy drugs, which retained the sensitivity of Mycobacterium tuberculosis (apartment houses Aseev).
Fix p.p. in low losing the affected lung due to pleural binding is performed by means of pleuroscopy and burnout adhesions on Jacobeus; in cases where these bridges are an obstacle to losing light, it is necessary to resort to surgery.
Complications. The most frequent complication is pneumometric arising, as a rule, in the first months after the imposition of artificial pneumothorax. Other complications P. I. - traumatic pneumothorax due to puncture the lung, subcutaneous and mediastinal emphysema, air embolism, a breach of collapse and the subsequent lack of smoothing of the lung. Cm. also Collapsotherapy, Tuberculosis, treatment.

Fig. 1. Some variants of the gas bubble: 1 - uniform; Mr. partial pneumothorax; 3 - partial pneumothorax with Trevignano the growths (subject to correction); 4 - negative selective pneumothorax; 5 - positive selective pneumothorax with atelectasis.
Fig. 2. Apparatus for the imposition of artificial pneumothorax factory "red": 1 and 6 - ballinderreen; 2 and 7 of metal racks; 3 - rubber tube, which connects the cylinders; 4 - rubber tube with cannula; 5 - wooden base; 8 - U-gauge with a scale; 9 - distributing valve; 10 - panel.
Fig. 3. The imposition of artificial pneumothorax (schematically). The pressure gauge shows a negative pressure in the pleural cavity; see the position of the needle. The lower figure is the structure of the chest wall (longitudinal section); 1 - leather; 2 - intercostal muscles; 3 - pereplavleni space; 4 - parietal pleura; 5 - visceral pleura; 6 - subcutaneous tissue.
Fig. 4. Effective right of artificial pneumothorax: 1 - radiograph before the imposition of artificial pneumothorax (cavity in the subclavian area); 2 - tomography caverns patient before the imposition of artificial pneumothorax; 3 - radiograph after the imposition of artificial pneumothorax (the cavern is not defined); 4 - the images of the same patient after imposition of artificial pneumothorax.