Patient Spirometry: Diagnosis and Treatment of Pneumothorax During Laparoscopy

Diagnosis and treatment of pneumothorax during laparoscopy

Case Report

22 year-old woman, 58 kg, 170 cm

Laparoscopic fundoplication performed in 10° head-up position. Intra-abdominal pressure 14 mmHg.

Case Evolution

I. Intra-abdominal CO₂ insufflation

• Compliance decreases
• Pplat increases
• ETCO₂ increases

II. Pneumothorax occurs - diagnosis

• Compliance decreases further
• Pplat increases further
• ETCO2 increases further
• The occurrence of pneumothorax was confirmed through fluoroscopy

III. Treatment with PEEP - improvement

• Compliance improves
• Pplat decreases gradually
• ETCO₂ decreases

IV. Deflation of the abdomen

Graphic evidence of efficacy of PEEP treatment

I = After CO₂ insufflation
II = After pneumothorax has developed
III = PEEP 6 cmH₂O – compliance improves
IV = PEEP 8 cmH₂O – compliance improves further

References

1. Joris JL, Chiche J-D, Lamy ML: Pneumothorax During Laparoscopic Fundoplication: Diagnosis and Treatment with Positive End-Expiratory Pressure, Anesth Analg; 81:993-1000, (1995).