Pneumothorax in chronically ventilated neuromuscular and chest wall restricted patients: A case series
Bibliographic record
Abstract
RATIONALE: Pneumothorax can occur in chronically ventilated neuromuscular and chest wall-restricted patients using noninvasive home mechanical ventilation (HMV) and airway clearance techniques. Limited descriptions of these cases and their management exist in the literature.OBJECTIVES: To understand the unique considerations in diagnosis and management of pneumothorax in the neuromuscular and chest wall-restricted patient population.METHODS: A retrospective chart review was performed at the Peter Lougheed Neuromuscular Respiratory Clinic between 2006 and 2017. A case series of six patients is presented.RESULTS: Median duration of HMV at time of the pneumothorax was 3 years (range 0.25-9 years). Five patients used airway clearance techniques. The mean forced vital capacity (FVC) was 1.0 L (27% predicted). Patients had a low mean body mass index (BMI) of 16 ± 3 kg/m2. Five of 6 patients required chest tube and had prolonged air leak (>48 hours). Four of 6 had recurrent pneumothoraces. One patient received chemical pleurodesis.CONCLUSIONS: Clinical suspicion and rapid diagnosis are necessary for pneumothorax in neuromuscular and chest wall-restricted patients dependent on HMV. CT imaging of the chest may be necessary. Management can include: reducing ventilator pressure settings, suspending airway clearance techniques and chest tube insertion. Chemical or surgical pleurodesis are felt to be high risk; however, recurrent pneumothorax was frequent in this cohort. Low BMI raises the possible association between malnutrition and risk of pneumothorax in patients receiving HMV.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".