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İLERİ YAŞ HASTALARDA PNÖMOTORAKS GELİŞMESİNİN NEDENLERİ VE MORTALİTE ORANLARININ ANALİZİ

Year 2025, Volume: 8 Issue: 2, 101 - 105, 30.06.2025

Suzan Temiz Bekce

https://doi.org/10.36516/jocass.1613123

Abstract

Amaç: Spontan pnömotoraks (SP) sıklıkla genç erkeklerde görülmekle birlikte, yaşlı yetişkinlerde genellikle ikincil bir durum olarak ortaya çıkmaktadır. Yaşlı hastalarda, altta yatan kronik akciğer hastalıkları nedeniyle Sekonder spontan pnömotoraks (SSP) hayatı tehdit eden ve acil tedavi gerektiren durumdur. Bu çalışmada 60 yaş ve üzeri hastalarda SSP etiyolojisinde yer alan hastalıklar, klinik özellikleri, tedavi biçimleri ve mortalitesini literatür verileri ışığında değerlendirilmesi amaçlandı.
Gereç ve Yöntemler: Çalışma, Ekim 2022 ile Temmuz 2024 tarihleri arasında SSP nedeniyle izlenen 60 yaş ve üzeri hastaların retrospektif olarak incelenmesi ve sonuçlarının analiz edilmesiyle gerçekleştirilmiştir.
Bulgular: SSP ile takip edilen, tüm dahil edilme ve dışlama kriterlerini karşılayan 60 hasta çalışmaya dahil edilmiştir. Hastaların yaş ortalaması 72.03±8.5 (60-91 yaş) olarak saptanmıştır. Çalışmada vakaların 54’ünde (%90) komorbid hastalıkların, 31’inde (%51.66) akciğer hastalığının eşlik ettiği belirlenmiştir. Hastaların 6’sı (%10) konservatif tedavi, 55’i (%91) tüp torakostomi uygulanarak izlenmiştir. Plörodezis 12 hastaya (%20) uygulanmıştır, uygulanan olguların atak sayısının azaldığı not edilmiştir (p=0.001). Görüntülemede büllöz yapının varlığı ile pnömotoraks atak sayısı arasında anlamlı ilişki görüldü (p=0.008).Vakaların %35’i pnömoni ile takip edilmiştir. Vefat eden hastaların 13'ünde pnömoni tespit edilmiştir, istatistiksel olarak anlamlı bulunmuştur (p<0.001).
Sonuç: SSP; zamanında müdahale edilmediğinde hayati tehlike oluşturabilen, ileri yaşta yönetimi zor olabilen bir klinik durumdur. Çalışmanın verileri değerlendirildiğinde; altta yatan akciğer hastalığının varlığı, görüntülemede büllöz yapının olması pnömotoraks atağı ve nüks açısından risk oluşturduğu görülmüştür. Yoğun bakım gerekliliği, komplikasyon gelişmesi ve pnömoninin eşlik etmesi mortalite ile ilişkili olmasıyla prognostik önem taşımaktadır.

Keywords

İleri yaş mortalite sekonder spontan pnömotoraks spontan pnömotoraks

References

  • 1. Gürz S, Gündoğdu H, Mehmetoğlu SS. Sudden Chest Pain and Shortness of Breath in Emergency Department; Spontaneous Pneumothorax. Anatolian J Emerg Med. 2019;2(2):5-9.
  • 2. Temiz G, Gülen M, Temiz G, et al. Analysis of Patients with Secondary Spontaneous Pneumothorax due to Chronic Obstructive Pulmonary Disease Admitted to The Emergency Department. Phnx Med J. 2019;1(1):20-25. [Crossref]
  • 3. Light RW, O’Hara VS, Moritz TE, et al. Intrapleural tetracycline for the prevention of recurrent spontaneous pneumothorax. Results of a department of veterans affairs cooperative study. JAMA 1990;264:2224-30[Crossref]
  • 4. Gupta D, Hansell A, Nichols T, et al. Epidemiology of pneumothorax in England. Thorax. 2000;55:666-71. [Crossref]
  • 5. Nishizawa S, Tobino K, Marukami Y, et al. Mortality and prognostic factors for spontaneous pneumothorax in older adults. PLoS ONE 2023;18:e0291233. [Crossref]
  • 6. West JB. Distribution of mechanical stress in the lung, a possible factor in localisation of pulmonary disease. Lancet 1971;1:839-41. [Crossref]
  • 7. Lippert HL, Lund O, Blegvad S, et al. Independent risk factors for cumulative recurrence rate after first spontaneous pneumothorax. Eur Respir J 1991;4:324-31
  • 8. Videm V, Pillgram-Larsen J, Ellingsen O, et al. Spontaneous pneumothorax in chronic obstructive pulmonary disease: complications, treatment and recurrences. Eur J Respir Dis 1987;71:365-71.
  • 9. Macduff A, Arnold A, Harvey J, on behalf of the BTS Pleural Disease Guideline Group. Management of spontaneous pneumothorax: British Thoracic Society pleural disease guideline 2010. Thorax 2010;65:ii18–31. [Crossref]
  • 10. Baumann MH, Strange C, Heffner JE, et al. Management of spontaneous pneumothorax: An American College of Chest Physicians Delphi consensus statement. Chest 2001;119:590–02. [Crossref]
  • 11. Bintcliffe OJ, Hallifax RJ, Edey A, et al. Spontaneous pneumothorax: time to rethink management? Lancet Respir Med 2015;3:578-88. [Crossref]
  • 12. Adewole OO, De Keukeleire T, Phillips AS, et al. Effectiveness of thoracoscopic talc pleurodesis in the management of complicated spontaneous pneumothorax. J Bronchology Interv Pulmonol 2015;22:48-51. [Crossref]
  • 13. Ashkenazi M, Bak A, Sarouk I, et al. Spontaneous pneumothorax -When do we need to intervene? Clin Respir J. 2021;15:967-72. [Crossref]
  • 14. Tanaka F, Itoh M, Esaki H, et al. Secondary spontaneous pneumothorax. Ann Thorac Surg. 1993;55:372–76. [Crossref]
  • 15. Çelik B, Nadir A, Şahin E, et al. Nüks spontan pnömotrakslı olgularda risk faktörleri, klinik ve radyolojik değerlendirme. Turkish J Thorac Cardiovasc Surg 2008;16:107-12
  • 16. Schoenenberger RA, Haefeli WE, Weiss P, et al. Timing of invasive procedures in therapy for primary and secondary spontaneous pneumothorax. Arch Surg 1991;126(6):764-66. [Crossref]
  • 17. Akcam TI, Kavurmaci O, Ergonul AG, et al. Analysis of the patients with simultaneous bilateral spontaneous pneumothorax. Clin Respir J. 2018;12:1207–11. [Crossref]
  • 18. Çelik B, Sürücü ZP, Yılmaz V, et al. A case report of secondary simultaneous bilateral pneumothorax due to pazopanib treatment. Turk Thorac J 2018;19(1):49-51. [Crossref]
  • 19. Sen BK, Basu M, Das S, et al. Unusual case of spontaneous bilateral pneumothorax secondary to osteosarcoma metastasis. J Assoc Physicians India 2016; 64-68
  • 20. Bintcliffe O, Maskell N. Spontaneous pneumothorax. BMJ 2014;348:g2928. [Crossref]
  • 21. Onuki T, Ueda S, Yamaoka M, et al. Primary and Secondary Spontaneous Pneumothorax: Prevalence, Clinical Features, and In-Hospital Mortality. Can Respir J. 2017;2017:6014967. [Crossref]
  • 22. Chen CH, Liao WC, Liu YH, et al. Secondary spontaneous pneumothorax: which associated conditions benefit from pigtail catheter treatment? Am J Emerg Med. 2012;30(1):45–50. [Crossref]
  • 23. Schnell J, Koryllos A, Lopez-Pastorini A, et al. Spontaneous Pneumothorax. Dtsch Arztebl Int. 2017;114(44):739–44. [Crossref]
  • 24. Thelle A, Gjerdevik M, SueChu M, et al. Randomised comparison of needle aspiration and chest tube drainage in spontaneous pneumothorax. Eur Respir J. 2017;49(4):1601296. [Crossref]

Causes of Pneumothorax in Patients of Advanced Age and Analysis of Mortality Rates

Year 2025, Volume: 8 Issue: 2, 101 - 105, 30.06.2025

Suzan Temiz Bekce

https://doi.org/10.36516/jocass.1613123

Abstract

Aim: Spontaneous pneumothorax (SP) primarily occurs in young males but typically presents as a secondary condition in older adults. Secondary spontaneous pneumothorax (SSP) is life-threatening and demands urgent treatment due to underlying chronic lung diseases. This study evaluates the etiological factors, clinical characteristics, treatment methods, and mortality of SSP in patients aged 60 and older, based on current literature.
Methods: This study was conducted by retrospectively analyzing the outcomes of patients aged 60 and older who were followed up for SSP between October 2022 and July 2024.
Results: The study included 60 patients who were followed up with SSP and met all inclusion and exclusion criteria. The mean age of the patients was 72.03±8.5 years (range: 60–91).
Comorbidities were present in 54 patients (90%), and pulmonary diseases were identified in 31 ca-ses (51.66%). Conservative treatment was applied in six patients (10%), while 55 patients (91%) underwent tube thoracostomy. Pleurodesis was performed in 12 patients (20%), resulting in a signi-ficant reduction in pneumothorax recurrence (p=0.001). Imaging revealed a significant association between bullous structures and the frequency of pneumothorax attacks (p=0.008). Pneumonia was diagnosed in 35% of cases, and mortality occurred in 13 patients, showing statistical significance (p<0.001).
Conclusion: SSP is a life-threatening condition requiring timely intervention, particularly challenging in elderly patients. Data indicate that underlying lung disease and bullous structures on imaging increase the risk of pneumothorax recurrence. Prognostic factors associated with mortality include intensive care needs, complications, and pneumonia, highlighting their significance in management outcomes.

Keywords

: advanced age mortality secondary spontaneous pneumothorax secondary spontaneous pneumothorax

References

  • 1. Gürz S, Gündoğdu H, Mehmetoğlu SS. Sudden Chest Pain and Shortness of Breath in Emergency Department; Spontaneous Pneumothorax. Anatolian J Emerg Med. 2019;2(2):5-9.
  • 2. Temiz G, Gülen M, Temiz G, et al. Analysis of Patients with Secondary Spontaneous Pneumothorax due to Chronic Obstructive Pulmonary Disease Admitted to The Emergency Department. Phnx Med J. 2019;1(1):20-25. [Crossref]
  • 3. Light RW, O’Hara VS, Moritz TE, et al. Intrapleural tetracycline for the prevention of recurrent spontaneous pneumothorax. Results of a department of veterans affairs cooperative study. JAMA 1990;264:2224-30[Crossref]
  • 4. Gupta D, Hansell A, Nichols T, et al. Epidemiology of pneumothorax in England. Thorax. 2000;55:666-71. [Crossref]
  • 5. Nishizawa S, Tobino K, Marukami Y, et al. Mortality and prognostic factors for spontaneous pneumothorax in older adults. PLoS ONE 2023;18:e0291233. [Crossref]
  • 6. West JB. Distribution of mechanical stress in the lung, a possible factor in localisation of pulmonary disease. Lancet 1971;1:839-41. [Crossref]
  • 7. Lippert HL, Lund O, Blegvad S, et al. Independent risk factors for cumulative recurrence rate after first spontaneous pneumothorax. Eur Respir J 1991;4:324-31
  • 8. Videm V, Pillgram-Larsen J, Ellingsen O, et al. Spontaneous pneumothorax in chronic obstructive pulmonary disease: complications, treatment and recurrences. Eur J Respir Dis 1987;71:365-71.
  • 9. Macduff A, Arnold A, Harvey J, on behalf of the BTS Pleural Disease Guideline Group. Management of spontaneous pneumothorax: British Thoracic Society pleural disease guideline 2010. Thorax 2010;65:ii18–31. [Crossref]
  • 10. Baumann MH, Strange C, Heffner JE, et al. Management of spontaneous pneumothorax: An American College of Chest Physicians Delphi consensus statement. Chest 2001;119:590–02. [Crossref]
  • 11. Bintcliffe OJ, Hallifax RJ, Edey A, et al. Spontaneous pneumothorax: time to rethink management? Lancet Respir Med 2015;3:578-88. [Crossref]
  • 12. Adewole OO, De Keukeleire T, Phillips AS, et al. Effectiveness of thoracoscopic talc pleurodesis in the management of complicated spontaneous pneumothorax. J Bronchology Interv Pulmonol 2015;22:48-51. [Crossref]
  • 13. Ashkenazi M, Bak A, Sarouk I, et al. Spontaneous pneumothorax -When do we need to intervene? Clin Respir J. 2021;15:967-72. [Crossref]
  • 14. Tanaka F, Itoh M, Esaki H, et al. Secondary spontaneous pneumothorax. Ann Thorac Surg. 1993;55:372–76. [Crossref]
  • 15. Çelik B, Nadir A, Şahin E, et al. Nüks spontan pnömotrakslı olgularda risk faktörleri, klinik ve radyolojik değerlendirme. Turkish J Thorac Cardiovasc Surg 2008;16:107-12
  • 16. Schoenenberger RA, Haefeli WE, Weiss P, et al. Timing of invasive procedures in therapy for primary and secondary spontaneous pneumothorax. Arch Surg 1991;126(6):764-66. [Crossref]
  • 17. Akcam TI, Kavurmaci O, Ergonul AG, et al. Analysis of the patients with simultaneous bilateral spontaneous pneumothorax. Clin Respir J. 2018;12:1207–11. [Crossref]
  • 18. Çelik B, Sürücü ZP, Yılmaz V, et al. A case report of secondary simultaneous bilateral pneumothorax due to pazopanib treatment. Turk Thorac J 2018;19(1):49-51. [Crossref]
  • 19. Sen BK, Basu M, Das S, et al. Unusual case of spontaneous bilateral pneumothorax secondary to osteosarcoma metastasis. J Assoc Physicians India 2016; 64-68
  • 20. Bintcliffe O, Maskell N. Spontaneous pneumothorax. BMJ 2014;348:g2928. [Crossref]
  • 21. Onuki T, Ueda S, Yamaoka M, et al. Primary and Secondary Spontaneous Pneumothorax: Prevalence, Clinical Features, and In-Hospital Mortality. Can Respir J. 2017;2017:6014967. [Crossref]
  • 22. Chen CH, Liao WC, Liu YH, et al. Secondary spontaneous pneumothorax: which associated conditions benefit from pigtail catheter treatment? Am J Emerg Med. 2012;30(1):45–50. [Crossref]
  • 23. Schnell J, Koryllos A, Lopez-Pastorini A, et al. Spontaneous Pneumothorax. Dtsch Arztebl Int. 2017;114(44):739–44. [Crossref]
  • 24. Thelle A, Gjerdevik M, SueChu M, et al. Randomised comparison of needle aspiration and chest tube drainage in spontaneous pneumothorax. Eur Respir J. 2017;49(4):1601296. [Crossref]
There are 24 citations in total.

Details

Primary Language English
Subjects Thoracic Surgery
Journal Section Articles
Authors

Suzan Temiz Bekce 0000-0003-1247-8485

Publication Date June 30, 2025
Submission Date January 4, 2025
Acceptance Date April 8, 2025
Published in Issue Year 2025 Volume: 8 Issue: 2

Cite

APA Temiz Bekce, S. (2025). Causes of Pneumothorax in Patients of Advanced Age and Analysis of Mortality Rates. Journal of Cukurova Anesthesia and Surgical Sciences, 8(2), 101-105. https://doi.org/10.36516/jocass.1613123
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