PTX - most common cause

 Q: The most common cause of iatrogenic pneumothorax is? (select one) 

 A) central venous catheterization (central line) 

 B) thoracentesis

C) barotrauma (mechanical ventilation) 

 D) exercise 

Answer: A

The objective of the question is to highlight the fact that thoracentesis is relatively a safer procedure in contrast to central lines. This becomes even safer in an experienced hand and under ultrasound guidance. Actually, the risk of pneumothorax is found to be more than double for central lines than for thoracentesis (44% vs 20%).  Added risk factors for pneumothoraces are emergently performed procedures and teaching hospitals. Barotrauma (choice C) and exercise (choice D) are relatively less frequent in comparison to other choices in the question.

#procedures

References:

1. Celik B, Sahin E, Nadir A, Kaptanoglu M. Iatrogenic pneumothorax: etiology, incidence and risk factors. Thorac Cardiovasc Surg 2009; 57:286. 

2. Smit JM, Raadsen R, Blans MJ, et al. Bedside ultrasound to detect central venous catheter misplacement and associated iatrogenic complications: a systematic review and meta-analysis. Crit Care 2018; 22:65. 

3. John J, Seifi A. Incidence of iatrogenic pneumothorax in the United States in teaching vs. non-teaching hospitals from 2000 to 2012. J Crit Care 2016; 34:66.