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Discussion

patients w/ pneumothorax

Can anyone tell me how to position a patient with a newly developed pneumothorax? Is it affected side down with good lung up or the other way around? I have heard this makes a difference in helping the patient breath better until a chest tube can be placed.

Thank you!

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It really depends on the etiology of the pneumothorax.

In terms of V/Q, if the lung is collapsing due to a higher intrapleural pressure-- placing the patient in semi-fowlers and trials with affected lung up might facilitate re-expansion of the lung.

In cases of pneumonitis/drainage or poor SVO2, placing the affected lung down will allow maximum ventilation and protection of the unaffected lung.

Studies have shown that after needle biopsy/intrapleural drainage, there is no difference in post-procedure outcome related to positioning.

Generally, to limit exacerbating VQ mismatch, place the patient in mid-high fowler's, and provide frequent 15 deg rotation.

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