Sign In
CPSI Share                 

​AHRQ Quality Indicators Toolkit. Selected best practices and suggestions for improvement PSI 6: Iatrogenic pneumothorax. Rockville, MD: AHRQ; 2014.

The Acute Respiratory Distress Syndrome Network (ARDS). Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med. 2000; 342 (18): 1301-1308.

Amato MB, Barbas CS, Medeiros DM, Magaldi RB, et al. Effect of a protective–ventilation strategy on mortality in the acute respiratory distress syndrome. N Engl J Med. 1998; 338 (6): 347-354.

Anzueto A, Frutos-Vivar G, Esteban A, et al. Incidence, risk factors and outcome of barotraumas in mechanically ventilated patients. Intensive Care Med. 2004; 30 (4): 612-619.

Azad C; Parmar V; Aggarwal P. Massive cerebral air embolism on ante mortem CT head following pneumothorax in a child with pneumonia. J Tropical Pediatr. 2011; 57 (6): 490-2.

Bailey SH, Shapiro SB, Mone MC, Saffle JR, Morris SE, Barton RG. Is immediate chest radiograph necessary after central venous catheter placement in a surgical intensive care unit? Am J Surg. 2000; 180 (6): 517-521.

Barnes TW, Morgenthaler TI, Olson EJ, et al. Sonographically guided thoracentesis and rate of pneumothorax. J Clin Ultrasound. 2005; 33:442-6.

Boussarsar M, Thierry G, Jaber S, et al. Relationship between ventilatory settings and barotrauma in the acute respiratory distress syndrome. Intensive Care Med. 2002; 28 (4): 406-413.

Brenner B, Corbridge T, Kazzi A. Intubation and mechanical ventilation of the asthmatic patient in respiratory failure. J Emerg Med. 2009; 37 (2S0): S23-S34. doi: 10.1016/j.jemermed.2009.06.108.

Briel M, Meade M, Mercat A , et al. Higher vs lower positive end-expiratory pressure in patients with acute lung injury and acute respiratory distress syndrome: systematic review and meta-analysis. JAMA . 2010; 303 ( 9 ): 865-873. doi: 10.1001/jama.2010.218.

Carron M, Gagliardi G, Michielan F, Freo U, Ori C. Occurrence of pneumothorax during noninvasive positive pressure ventilation through a helmet. J Clin Anesth. 2007; 19 (8): 632-635.

Cavanna L, Anselmi E, Di Nunzio C. Ultrasound guidance of central venous catheterization: towards a zero risk of iatrogenic pneumothorax. Thorac Cardiovasc Surg. 2010; 58 (4): 255. doi: 10.1055/s-0029-1240927.

Çelik B, E. Sahin, A. Nadir, M. Kaptanoglu. Iatrogenic pneumothorax: Etiology, incidence and risk Factors. Thorac Cardiov Surg. 2009; 57 (5): 286-290. doi: 10.1055/s-0029-1185365.

Chebel NA, Ziade D, Achkouty R. Bilateral pneumothorax and pneumomediastinum after treatment with continuous positive airway pressure after orthognathic surgery. Br J Oral Maxillofac Surg. 2010; 48 (4): e14-15. doi: 10.1016/j.bjoms.2009.12.005.

Chen KY, Jerng JS, Liao WY, et al. Pneumothorax in the ICU: patient outcomes and prognostic factors. Chest. 2002; 122 (2): 678-683.

Choi C, Um S, Yoo C, et al. Incidence and risk factors of delayed pneumothorax after transthoracic needle biopsy of the lung. Chest. 2004; 126(5), 1516-1521.

Cox JE, Chiles C, McManus CM, Aquino SL, Choplin RH. Transthoracic Needle Aspiration Biopsy: Variables That Affect Risk of Pneumothorax. Radiology. 1999; 212(1), 165-168.

De Lassence A, Timsit JF, Tafflet M, et al. Pneumothorax in the intensive care unit. Incidence, Risk Factors, and Outcome. Anesthesiology. 2006; 104 (1): 5-13.

Diacon AH, Brutsche M, Solèr M. Accuracy of pleural puncture sites prospective comparison of clinical examination with ultrasound. Chest. 2003; 123 (2): 436-441.

Duncan DR, Morgenthaler TI, Ryu JH, Daniels CE. Reducing iatrogenic risk in thoracentesis: Establishing best practice via experiential training in a zero-risk environment. Chest. 2009; 135 (5) :1315-1320. doi: 10.1378/chest.08-1227.

Esteban A, Anzueto A, Frutos F, et al. Characteristics and outcomes in adult patients receiving mechanical ventilation: a 28-day international study. JAMA. 2002; 287 (3): 345-355.

Gattinoni L, Bombino M, Pelosi P, at al. Lung structure and function in different stages of severe adult respiratory distress syndrome. JAMA. 1994; 271 (22): 1772-1779.

Gordon CE, Feller-Kopman D, Balk EM, Smetana GW. Pneumothorax following thoracentesis: a systematic review and meta-analysis. Arch Intern Med. 2010; 170 (4): 332-329. doi: 10.1001/archinternmed.2009.548.

Havelock T, Teoh R, Laws D, Gleeson F, BTS Pleural Disease Guideline Group. Pleural procedures and thoracic ultrasound: British Thoracic Society pleural disease guideline 2010. Thorax. 2010; 65 (Suppl 2): ii61-ii76. doi: 10.1136/thx.2010.137026.

Haynes D, Baumann MH. Management of pneumothorax. Semin Respir and Crit Care Med. 2010; 31 (6): 769-779. doi: 10.1055/s-0030-1269837.

Health Quality Council of Alberta (HQCA). The safe practice of dry needling in Alberta: Summary report. Calgary, AB: HQCA; 2014.

Hegde S, Prodhan P. Serious air leak syndrome complicating high-flow nasal cannula therapy: a report of 3 cases. Pediatrics. 2013; 131 (3): e939-e944. doi: 10.1542/peds.2011-3767.

Hsu CW, Sun SF. Iatrogenic pneumothorax related to mechanical ventilation. World J Crit Care Med. 2014; 3 (1): 8-14. doi: 10.5492/wjccm.v3.i1.8.

Ibrahim AE, Stanwood PL, Freund PR. Pneumothorax and systemic air embolism during positive-pressure ventilation. Anesthesiology. 1999; 90 (5): 1479-81.

Institute for Healthcare Improvement (IHI). How-to Guide: Prevent Harm from High-Alert Medications. Cambridge, MA: IHI; 2012. (Available at

Johnson NN, Toledo A, Endom EE. Pneumothorax, pneumomediastinum and pulmonary embolism. Pediatr Clin N Am. 2010; 57 (6): 1357-1383. doi: 10.1016/j.pcl.2010.09.009.

Kopterides P, Siempos II, Armaganidis A. Prone positioning in hypoxemic respiratory failure: meta-analysis of randomized controlled trials. J Crit Care. 2009; 24 (1): 89-100. doi: 10.1016/j.jcrc.2007.12.014.

Kumar S, Agarwal R, Aggarwal AN, Gupta D, Jindal SK. Role of ultrasonography in the diagnosis and management of pneumothorax following transbronchial lung biopsy. J Bronchology Interv Pulmonol. 2015; 22 (1): 14-19. doi: 10.1097/LBR.0000000000000125.

Lenchus JD, Barnes SK, Birnbach DJ. The impact of a standardized curriculum on reducing thoracentesis-induced pneumothorax. Arch InternMed. 2010; 170 (13): 1176-1177. doi: 10.1001/archinternmed.2010.217.

Light RW, Lee YCG. Chapter 18: Pneumothorax, chylothorax, hemothorax, and fibrothorax. In Broaddus VC, Mason RJ, Ernst JD et al. Murray and Nadel's Textbook of Respiratory Medicine, 6th Ed. Saunders, Elsevier: 2016; 1439-1460.

Loiselle A, Parish JM, Wilkens JA, Jaroszewski DE. Managing iatrogenic pneumothorax and chest tubes. J Hosp Med. 2013; 8 (7); 402-8. doi: 10.1002/jhm.2053.

Malone LJ, Stanfill RM, Wang H, Fahey KM, Bertino RE. Effect of intraparenchymal blood patch on rates of pneumothorax and pneumothorax requiring chest tube placement after percutaneous lung biopsy. AJR Am J Roentgenol. 2013; 200 (6): 1238-1243. doi: 10.2214/AJR.12.8980.

Mayo P, Beaulieu Y, Doelken P., et al. American College of Chest Physicians/La Société de Réanimation de Langue Française: competence in critical care ultrasonography. Chest. 2009;135:1050-60. Available at:

Milési C, Boubal M, Jacquot A, et al. High-flow nasal cannula: recommendations for daily practice in pediatrics. Ann Intensive Care. 2014; 30 (4): 29. doi: 10.1186/s13613-014-0029-5.

Miller MP, Sagy M. Pressure characteristics of mechanical ventilation and incidence of pneumothorax before and after the implementation of protective lung strategies in the management of pediatric patients with severe ARDS. Chest. 2008; 134 (5): 969-973. doi: 10.1378/chest.08-0743.

Min L, Xu X, Song Y, et al. Breath-hold after forced expiration before removal of the biopsy needle decreased the rate of pneumothorax in CT-guided transthoracic lung biopsy. Eur J Radiol. 2013; 82 (1): 187-190. doi: 10.1016/j.ejrad.2012.09.013.

Molgaard O, Nielsen MS, Handberg BB, Jensen JM, Kjaergaard J, Juul N. Routine x-ray control of upper central venous lines: is it necessary? Acta Anaesthesiol Scand. 2004; 48 (6): 685–689.

National Institute for Health and Care Excellence (NICE). Guidance for interventional procedures. 2015.

Nyman AG, Sonnappa S, Prendiville AT, Jaffe A. Ventilation induced pneumothorax following resolved empyema. Pediatr Pulmonol. 2008; 43 (1): 99-101.

O'Boyle AL, Mink RB, Anas NG, Kallay TC. Development of learning objectives and a validated testing tool for management of pediatric mechanical ventilation. Pediatr Crit Care Med. 2014; 15 (7): 594-599. doi: 10.1097/PCC.0000000000000195.

Papazian L, Forel JM, Gacouin A, et al. Neuromuscular blockers in early acute respiratory distress syndrome. N Engl J Med. 2010; 363 (12): 1107 - 1116. doi: 10.1056/NEJMoa1005372.

Schnapp LM, Chin DP, Szaflarski N, Matthay MA. Frequency and importance of barotrauma in 100 patients with acute lung injury. Crit Care Med. 1995; 23 (2): 272–278.

Tran AA, Brown SB, Rosenberg J, Hovsepian DM. Tract embolization with gelatin sponge slurry for prevention of pneumothorax after percutaneous computed tomography-guided lung biopsy. Cardiovasc Intervent Radiol. 2014; 37 (6): 1546-1553. doi: 10.1007/s00270-013-0823-8.

Troianos C, Hartman GS, Glas KE et al. Guidelines for performing ultrasound guided vascular cannulation: Recommendations of the American Society of Echocardiography and the Society of Cardiovascular Anesthesiologists. Anesth Analg. 2012; 114(1): 46-72. doi: 10.1213/ANE.0b013e3182407cd8.

Vianello A, Arcaro G, Gallan F, Ori C, Bevilacqua M. Pneumothorax associated with long-term non-invasive positive pressure ventilation in Duchenne muscular dystrophy. Neuromuscul Disord. 2004; 14 (6): 353-355.

Volpicelli G, Elbarbary M, Blaivas M, et al. International evidence-based recommendations for point-of-care lung ultrasound. Intensive Care Med 2012; 38: 577–591. doi: 10.1007/s00134-012-2513-4.

Wang HJ, Leung TK, Lee CM, Chen YY. Three-step needle withdrawal method: a modified technique for reducing the rate of pneumothorax after CT-guided lung biopsy. Chang Gung Med J. 2009; 32 (4): 432-437.

Weg JG, Anzueto A, Balk RA, et al. The relation of pneumothorax and other air leaks to mortality in the acute respiratory distress syndrome. N Engl J Med. 1998; 338 (6): 341–346.

Wrightson J, Fysh E, Maskell N, et al. Risk reduction in pleural procedures: sonography,simulation, and supervision. Curr Opin Pulm Med 2010;16:340-50.

Zaetta JM, Licht MO, Fisher JS, Avelar RL, Bio-Seal Study Group. A lung biopsy tract plug for reduction of postbiopsy pneumothorax and other complications: results of prospective, multicenter, randomized, controlled clinical study. J Vasc Interv Radiol. 2010; 21 (8): 1235-1243. doi: 10.1016/j.jvir.2010.04.021.

Zhan C, Smith M, Stryer D. Accidental iatrogenic pneumothorax in hospitalized patients. Med Care. 2006; 44 (2): 182-86.