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Pneumothorax requiring positive pressure ventilation — SCE Respiratory MCQ

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HardPleural DiseasePneumothorax requiring positive pressure ventilationSCE Respiratory

A 70-year-old woman with severe COPD has a secondary spontaneous pneumothorax and acute hypercapnic respiratory failure. She is being considered for NIV, but CXR shows a 3 cm right pneumothorax and she is breathless despite controlled oxygen. What is the most appropriate ventilation strategy?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: A — Insert an intercostal chest drain before starting positive pressure ventilation

Positive pressure ventilation can enlarge an untreated pneumothorax, so a clinically significant pneumothorax should be drained before NIV when ventilation is needed. NIV or CPAP without drainage risks deterioration, particularly in secondary pneumothorax with limited reserve. Pleurodesis may be considered later for recurrence prevention but does not replace acute drainage.

Reference: BTS Pleural Disease Guideline 2023; BTS/ICS AHRF Guideline