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Medical and surgical management of pneumothorax in diving and hyperbaric chambers

ABSTRACT

Clarke RE, Van Meter K. Medical and surgical management of pneumothorax in diving and hyperbaric chambers. Undersea Hyperb Med. 2024 First Quarter; 51(1):17-28.

The presence of a pneumothorax within a pressurized chamber represents unique diagnostic and management challenges. This is particularly the case in the medical and geographic remoteness of
many chamber locations. Upon commencing chamber decompression, unvented intrapleural air
expands. If its initial volume and/or degree of chamber pressure reduction is significant enough, a tension pneumothorax will result. Numerous reports chronicle failure to diagnose and manage in- chamber pneumothorax with resultant morbidity and one fatal outcome. Such cases have occurred
in both medically remote and clinically based settings. This paper reviews pneumothorax and tension pneumothorax risk factors and clinical characteristics. It suggests primary medical management using the principle of oxygen-induced inherent unsaturation in concert with titrated chamber decompression designed to prevent intrapleural air expanding faster than it contracts. Should this conservative approach prove unsuccessful, and surgical venting becomes necessary or otherwise immediately indicated, interventional options are reviewed.

Keywords: chest tube; inherent unsaturation; pigtail catheter; recompression chamber; saturation decompression; tension pneumothorax; thoracotomy

DOI:10.22462/651