Pneumothorax (Collapsed Lung)

Anatomy
The human respiratory system is divided into the upper and lower
respiratory tracts.

 Upper respiratory tract

The major passages and structures of the upper respiratory tract
include the nose or nostrils, nasal cavity, mouth, throat
(pharynx), and voice box (larynx).
cont.
When you breathe in through your nose or mouth, the air is "filtered" through natural
lines of defense that protect against illness and irritation of the respiratory tract.
Nasal hairs (vibrissae) at the opening of the nostrils trap large particles of dust that
might otherwise be inhaled. The entire respiratory system, as with the reproductive,
digestive, and urinary systems, is lined with a mucous membrane that secretes mucus.
The mucus traps smaller particles like pollen or smoke. Hairlike structures called cilia
line the mucous membrane and move the particles trapped in the mucus out of the
nose.

Inhaled air is moistened, warmed, and cleansed by the nasal epithelium (the tissue
that lines the nasal cavity), which covers the turbinate bones (conchae) in the nasal
cavity. The nasal epithelium has increased blood flow that helps to warm the inhaled
air, but also facilitates nosebleeds in some people.

The pharynx is a muscular, funnel-shaped tube about 5 inches long that connects the
nasal and oral cavities to the larynx. The pharynx houses the tonsils and the adenoids,
which are lymphatic tissues that guard against infection by releasing white blood cells
(T and B lymphocytes).
The larynx forms the entrance to the lower respiratory system. With the help of the
epiglottis (a leaf-shaped flap), the larynx prevents food or liquid from entering the
lower respiratory tract while swallowing. Two pairs of strong connective tissue bands
that are stretched across the larynx vibrate to produce sounds while talking or singing.
Lower respiratory tract
The major passages and structures of the lower respiratory tract include the
windpipe (trachea) and within the lungs, the bronchi, bronchioles, and alveoli.

After the inhaled air moves through the larynx, it reaches the trachea. The
trachea is a rigid, muscular tube about 4.5 inches long and 1 inch wide.
Embedded in the walls of the trachea, C-shaped cartilage rings give the
trachea rigidity and allow it to stay open all the time.
Cont.

Inward airflow from the trachea then branches off to the two
bronchi. One bronchus leads to the right lung, the other to the
left lung. The bronchi also contain C-shaped cartilage rings like
the trachea.
Deeper in the lungs, each bronchus divides into secondary and
tertiary bronchi, which continue to branch to smaller airways
called the bronchioles. There is no cartilage in the bronchioles,
and therefore they are subject to constriction and obstruction,as
during an asthma attack. The bronchioles end in air sacs called
the alveoli. Alveoli are bunched together into clusters to form
alveolar sacs. On the surface of each alveolus, there is a network
of capillaries carrying blood that has come through veins from
other parts of the body. Here gas exchange occurs -- carbon
dioxide from the blood is exchanged for oxygen from the alveoli.
After the blood is oxygenated, it goes to the heart (between the
two lungs), where it is pumped out to all of the body tissues and
extremities. When you breathe out, the carbon dioxide is exhaled
and expelled from the body.
Definition
 A collapsed lung (pneumothorax) results from a buildup of air in the space
between the lung and the chest wall (pleural space). As the amount of air
in this space increases, the pressure against the lung causes the lung to
collapse. This prevents your lung from expanding properly when you try to
breathe in, causing shortness of breath and chest pain.
 A pneumothorax may become life-threatening if the pressure in your
chest prevents the lungs from getting enough oxygen into the blood.
Collapsed and normal lung

 A pneumothorax occurs when air gets between your lungs and chest wall,
causing part, or more rarely, the entire lung to collapse. In the example
shown, the left lung is more than 75 percent collapsed
Nursing Diagnosis
 Ineffective airway clearance- Inability to clear secretions or
obstructions from the respiratory tract to maintain a clear airway.
 Impaired gas exchange- Excess or deficit in oxygenation and/ or
carbon dioxide elimination at the alveolar-capillary membrane.
 Risk for aspiration- At risk for entry of gastrointestinal secretions,
oropharyngeal secretions, solids or fluids into tracheobronchial
passages.
 Ineffective breathing pattern- Inspiration and/ or expiration that
does not provide adequate ventilation
Clinical manifestation
If only a small amount of air enters the pleural space, you may have
few signs or symptoms, though even a minimally collapsed lung is
likely to cause some chest pain. When your lung has collapsed 25
percent or more, you're likely to experience:

 Sudden, sharp chest pain on the same side as the affected lung
 Shortness of breath, which may be more or less severe, depending
on how much of the lung is collapsed
 A feeling of tightness in your chest
 A rapid heart rate
 Because a tension pneumothorax can compress the walls of your
heart as well as the unaffected lung, heart function may be
impaired, leading to a potentially fatal drop in blood pressure
Etiology
It can result from:
 A penetrating chest wound
 Barotrauma to the lungs
 Spontaneously (most commonly in tall slim young males and in Marfan syndrome)
 Chronic lung pathologies including emphysema, asthma
 Acute infections
 Acupuncture
 Chronic infections, such as tuberculosis
 Cancer
 Catamenial pneumothorax (due to endometriosis in the chest cavity)

Pneumothoraces are divided into tension and non-tension pneumathoraces. A

tension pneumothorax is a medical emergency as air accumulates in the pleural
space with each breath. The remorseless increase in intrathoracic pressure
results in massive shifts of the mediastinum away from the affected lung
compressing intrathoracic vessels. A non-tension pneumothorax by contrast is
a less severe pathology because there is no ongoing accumulation of air and
hence no increasing pressure on the organs within the chest.
The accumulation of blood in the thoracic cavity (hemothorax) exacerbates the
problem, creating a pneumohemothorax.
Pathophysiology
 The lungs are located inside the chest cavity, which is a hollow
space. Air is drawn into the lungs by the diaphragm (a powerful
abdominal muscle). The pleural cavity is the region between the
chest wall and the lungs. If air enters the pleural cavity, either
from the outside (open pneumothorax) or from the lung (closed
pneumothorax), the lung collapses and it becomes mechanically
impossible for the injured person to breathe, even with an open
airway. If a piece of tissue forms a one-way valve that allows
air to enter the pleural cavity from the lung but not to escape,
overpressure can build up with every breath; this is known as
tension pneumothorax. It may lead to severe shortness of breath
as well as circulatory collapse, both life-threatening conditions.
This condition requires urgent intervention.
Causes
Your two lungs are separated by your heart, airways and the
major blood vessels in the center of your chest (mediastinum).All
these structures are enclosed by your chest wall, a combination
of ribs, cartilage and muscle.

Each lung is covered by a thin, moist tissue called the pleura,

which also lines the chest wall. The two layers of pleura are like
pieces of smooth satin that allow your lungs to expand and
contract easily.

Your lungs and chest wall are both elastic, but as you inhale and
exhale, your lungs recoil inward while your chest wall expands
outward. The two opposing forces create a negative pressure in
the pleural space between your rib cage and lung. When air
enters that space, either from inside or outside your lungs, the
pressure it exerts can cause all or part of the affected lung to
collapse.
There are several types of pneumothorax, which are defined according to what
causes them:

 Spontaneous (Primary) pneumothorax 
Spontaneous pneumothorax occurs in individuals with no known lung disease.  It
affects close to 9,000 persons in the United States each year- most often
among tall, thin men between 20 and 40 years old.  The cause of this type of
pneumothorax is the rupture of a bleb or cyst in the lung. 
Symptoms include:
 Chest pain on affected side 
 Dyspnea (shortness of breath)
 Cough
 Abnormal breathing movement
 Rapid respiratory rate
 Spontaneous pneumothorax is diagnosed by chest radiographs. 
 The way the condition is treated is dependant on its size and course.  The
objective of treatment is to remove the air from the pleural space, allowing
the lung to reexpand.  A small pneumothorax will resolve on its own in 1 to 2
weeks.  Larger pneumothoraxes require either needle aspiration or a chest
tube.  Hospitalization is required for chest tube management as the
reexpansion of the lung may take several days with the chest tube left in
place.  Surgery may be performed for a repeated episode to prevent
recurrence
 Secondary spontaneous pneumothorax-occurs in the setting of known lung
disease, most often chronic obstructive pulmonary disease (COPD).  Other lung
diseases commonly associated with spontaneous pneumothorax include tuberculosis,
pneumonia, asthma, cystic fibrosis, lung cancer, and certain forms of interstitial lung
disease.  This condition is generally severe and often life threatening. 
Symptoms and diagnostic procedures of secondary pneumothorax are identical to that
of primary spontaneous pneumothorax.
 
The therapeutic options for this condition are also the same as those for primary
spontaneous pneumothorax, but the circumstances are much more urgent.  A small
pneumothorax can be life threatening and virtually all patients are treated with chest
tubes.  Sudden death may occur before chest tubes can be place and respiratory
failure can occur within hours after the tubes are inserted.  The mortality rate
associated with secondary pneumothorax is high (15%)
. 
The recurrence rate for both primary and secondary spontaneous pneumothorax is
about 40% and occurs in intervals of 1.5 to 2 years.
 Patients suffering from this condition should be advised to
discontinue smoking and avoid high altitudes, scuba diving, or flying
in unpressurized aircrafts to prevent the recurrence of
pneumothorax.

 Traumatic pneumothorax- Any blunt or penetrating injury to your

chest can cause lung collapse. Knife and gunshot wounds, a blow to
the chest, even a deployed air bag can cause a pneumothorax. So
can injuries that inadvertently occur during certain medical
procedures such as the insertion of chest tubes, cardiopulmonary
resuscitation (CPR) and lung or liver biopsies. Pneumothorax is
especially common in people whose breathing is aided by a
mechanical ventilator.

 Tension pneumothorax- The most serious type of pneumothorax,

this occurs when the pressure in the pleural space is greater than
the atmospheric pressure, either because air becomes trapped in
the pleural space or because the entering air is from a positive-
pressure mechanical ventilator. The force of the air can cause the
affected lung to collapse completely. It can also push the heart
toward the uncollapsed lung, compressing both it and the heart.
Tension pneumothorax comes on suddenly, progresses rapidly and is
fatal if not treated quickly.
Chest X-ray of Left-sided Tension
pneumothorax
Risk Factors
 Sex- In general, men are far more likely to have a pneumothorax
than women are, though women can develop a rare form of
pneumothorax (catamenial pneumothorax) related to the menstrual
cycle. Catamenial pneumothorax, which mainly affects women in
their 20s and 30s, seems to occur when endometrial tissue — the
tissue that normally lines the uterus — spreads to the lungs,
pleura or diaphragm.

 Smoking- This is the leading risk factor for primary spontaneous

pneumothorax; more than 90 percent of people with a primary
pneumothorax are smokers or former smokers. The risk increases
with the length of time and the number of cigarettes smoked.

 Lung disease- Having another lung disease, especially emphysema,

makes a collapsed lung more likely.

 A history of pneumothorax- If you've had one pneumothorax,

you're at increased risk of another, usually within one to two
years of the first episode. This is especially true if the first
pneumothorax was small and healed on its own.
Screening and diagnosis
Most often, your doctor will diagnose a pneumothorax using a chest
X-ray. Other tests are sometimes performed, including:

 Computerized tomography (CT) scan-In certain cases, you may have

a computerized tomography (CT) scan, an X-ray technique that
produces more detailed images than conventional X-rays do. This is
most often done if your doctor suspects a pneumothorax after an
abdominal or chest procedure. A CT scan can help determine
whether an underlying disease may have caused your lung to collapse
— something that may not show up on a regular X-ray.

 Blood tests-These may be used to measure the level of oxygen in

your arterial blood.

Complications
The most common complication of a spontaneous or traumatic
pneumothorax is a recurrence — close to half the people who have
had one pneumothorax have another, usually within a year or two of
the first. You're more likely to have more than one pneumothorax if
you smoke, have an existing lung disease or HIV/AIDS, or are tall
and thin. And if you've had a primary spontaneous penumothorax
from a ruptured bleb, it's highly possible that you have or will
develop a similar bleb in the opposite lung.
Complications of a tension pneumothorax are more serious and include:

Low blood oxygen levels (hypoxemia)- Because a tension pneumothorax causes near or total
collapse of one lung and can compress the other, you take in less air and less oxygen enters
your bloodstream. As a result, you develop lower than normal blood oxygen levels. Lack of
oxygen can disrupt your body's basic functioning, and severely low levels can be life-
threatening.

Respiratory failure- This occurs when blood levels of oxygen fall too low, and the level of
carbon dioxide becomes too high. Severely low blood oxygen can lead to heart arrhythmias and
unconsciousness, and high carbon dioxide levels to sleepiness and confusion. Eventually,
respiratory failure may prove fatal.

Cardiac arrest- In a tension pneumothorax, the heart is pushed toward the unaffected lung.
This can interfere with the return of blood to the heart and lead to a sudden loss of heart
function. Cardiac arrest is fatal if not treated immediately.

 Shock- This critical condition occurs when blood pressure drops so low that the body's vital
organs are deprived of oxygen and nutrients. Shock is a major medical emergency and requires
immediate care.
Treatment
The goal in treating a pneumothorax is to relieve the pressure on the lung, allowing it to re-
expand, and to prevent recurrences. The best method for achieving this depends on the
severity of the lung collapse and sometimes on your overall health:
 Observation- If your lung is less than 20 percent to 25 percent collapsed, your doctor may
simply monitor your condition with a series of chest X-rays until the air is completely
absorbed and your lung has re-expanded. Because it may take weeks for a pneumothorax to
heal on its own, however, a needle or chest tube may be used to remove the air, even when
the pneumothorax is small and nonthreatening.

 Needle or chest tube insertion- When your lung has collapsed more than 25 percent, your
doctor is likely to remove the air by inserting a needle or hollow tube (chest tube) into the
pleural space. Chest tubes often are attached to a suction device that continuously removes
air from the chest cavity and may be left in place for several hours to several days.

 Other pneumothorax treatments- If you have had more than one pneumothorax, you may have
treatments to prevent further recurrences. The most common is a surgical procedure called
video-assisted thoracoscopy, which uses small incisions and a tiny video camera to guide the
surgery. This technique leads to less pain and a shorter recovery time than other types of
surgery do because the chest cavity can be accessed without breaking any ribs.
Pretreatment evaluation
 The radiographic diagnosis of pneumothorax is usually
straightforward (fig 1). A visceral pleural line is seen without distal
lung markings. Lateral or decubitus views are recommended for
equivocal cases. On standard lateral views a visceral pleural line
may be seen in the retrosternal position or overlying the vertebrae,
parallel to the chest wall. Shoot-through lateral or decubitus views
may be used in ventilated patients or neonates. Although the value
of expiratory views is controversial many clinicians still find them
useful in the detection of small pneumothoraxes when clinical
suspicion is high and an inspiratory radiograph appears normal. The
British Thoracic Society guidelines divide pneumothoraxes into small
and large based on the distance from visceral pleural surface (lung
edge) to chest wall, with less than 2 cm being small and more than
2 cm large. A small rim of air around the lung actually translates
into a relatively large loss of lung volume, with a 2 cm deep
pneumothorax occupying about 50% of the hemithorax. A large
pneumothorax is an objective indication for drainage.
In the supine patient, air in the pleural space will usually be most
readily visible at the lung bases (fig 2) in the cardiophrenic recess
and may enlarge the costophrenic angle (the deep sulcus sign).
Adherence of inflamed pleura to the chest wall may confine a
pneumothorax to a loculated portion of the pleural space around the
site of the air leak (fig 3). A drain placed remote from this area
will be ineffective at best. If the operator enters the chest at a
site of adherent pleura, parenchymal damage and a severe air leak
may follow (fig 4). For this reason, in the authors' opinion, loculated
pneumothoraxes are best approached under direct fluoroscopic and
occasionally computed tomography guidance. Emphysematous bullae
may alsomimic a loculated pneumothorax, particularly when there is a
background of chronic lung disease. Sometimes internal lung markings
are visible in a bulla using a bright light. If there is clinical doubt in
a patient with symptoms then computed tomography is helpful.
The chest radiograph should also be carefully examined for evidence
of underlying parenchymal lung disease (fig 5). The most common of
these predisposing to pneumothorax are emphysema, pulmonary
fibrosis of any cause, cystic fibrosis, aggressive or cavitating
pneumonia, and cystic interstitial lung diseases such as Langerhans'
cell histiocytosis and lymphangiomyomatosis. Detection of an
underlying condition is important for several reasons. Firstly, therapy
of the parenchymal lung disease may be possible. Secondly, unlike
primary spontaneous pneumothorax, patients with secondary air leaks
are not candidates for early discharge and require inpatient
observation.Finally, all but the smallest (defined as apical or less
than 1 cm in depth) secondary pneumothoraxes require treatment,
even when symptoms are minimal.

Several well known artefactual appearances can mimic the presence

of a pneumothorax and should always be remembered during
evaluation of a chest radiograph. The medial border of the scapula
can imitate a lung edge but once considered can be traced in
continuity with the rest of the bone, revealing its true nature (fig 5
). Skin folds overlying the chest wall (fig 6) can simulate a visceral
pleural line and with the relative lack of lung markings in the upper
zones can lead to erroneous diagnosis, particularly in children.
Once considered, however, their true nature is readily apparent. Skin folds are
usually seen to pass outside the chest cavity, are straight or only minimally
curved, and do not run parallel to the chest wall as with a true visceral pleural
line. If closely scrutinised, distal lung markings are seen. Clothing or bed sheets
may produce a similar artefact. Skin folds also form a dense line—sharp on one
side and blurred on the other—in contrast to the less dense visceral pleural line.
The latter distinction can, however, be rather subjective. Occasionally, doubt
persists. In this situation, repeat radiography after removal of clothing and
repositioning of the arm will be conclusive. Radio-opaque lines are often seen
accompanying the inferior margins of ribs, which may simulate a visceral pleural
line. These are often called companion shadows although some restrict this term
to densities accompanying the first and second ribs. They are caused by
protruding extrapleural fat or the subcostal groove. This normal variant is
characterised by its faithful relation to the inferior margin of the accompanying
rib, whereas visceral pleural lines diverge from the rib to parallel the chest wall.
Although usually close to the adjacent rib, companion shadows may sometimes
protrude inferiorly for a variable distance, giving a confusing appearance (fig 7).
After pleurectomy for recurrent pneumothorax a radio-opaque line may be visible
at the operative site due to suture material or staples (fig 8). This may be
misinterpreted as a new air leak, especially if compared with preoperative
radiographs or in ignorance of the history of previous surgery.
 Fig 1 (left) Classic appearances of left sided pneumothorax with readily apparent visceral pleural
line (arrow)

 Fig 2 (right) Supine projection showing air collected at lung base. Absent lung markings and a
visceral pleural line (arrow) are still visible (P=pneumothorax). Left basal chest drain is noted
 Fig 3 (left) Loculated left sided pneumothorax in a patient with severe chronic obstructive airways
disease. Placement of chest drain into fifth intercostal space (arrow) might have entered lung
parenchyma and would most likely not have achieved complete drainage of this loculated collection.
(right) Percutaneous pigtail catheters (arrows) placed in apical and basal components of pneumothorax
under fluoroscopic guidance. After several days of drainage the lung re-expanded completely

 Fig 4 Extensive pulmonary fibrosis and left pneumothorax (p) treated by blind chest drain placement.
Axial computed tomograpy shows that drain (arrow) has traversed lung parenchyma. This led to a
deterioration in patient's clinical condition
 Fig 5 Background fibrotic lung disease (underlying ulcerative colitis), which places patient
at risk of secondary pneumothorax. Although medial border of scapula (arrow) is easily
recognisable as such on this radiograph it can sometimes be misinterpreted as a visceral
pleural line

 Fig 6 (left) Skin folds (arrows) overlying right hemithorax. Distal lung markings are
readily apparent. Note folds are relatively straight unlike curved visceral pleural line of
pneumothorax
 Fig 7 (right) Prominent companion or accompanying shadow below left sixth rib
(arrow). Line is relatively parallel to accompanying rib, and distal lung markings
are evident

 Fig 8 This patient underwent pleurectomy for recurrent pneumothorax. Suture

material at right apex (arrow) is thicker than visceral pleural line and should not
be confused with recurrent air leak. Compare with adjacent apical pneumothorax
(arrowhead)
Post-treatment evaluation
 A post-drainage chest radiograph is essential after intervention to
document resolution of the pneumothorax, detect complications, and
ensure a satisfactory drain position. If tissue dissection at a drain
insertion site is too superficial, a subcutaneous or intramuscular plane
may be identified by the operator's finger and lead to drain
placement outside the pleural space in an ineffective position. This is
more likely to occur if the drain is sited at a posterior location, and
subsequent radiographic position may appear satisfactory on the
frontal film (fig 9). A lateral view or computed tomography
examination will detect this problem. An adequate length of drain
must also be inserted so that all side holes are contained within the
pleural space. Failure to do so leads to inadequate drainage and air
passage into subcutaneous tissues. The length of the tube with side
holes can be identified on standard surgical chest drains by a gap in
the radio-opaque marker line (fig 10). After satisfactory resolution
of the pneumothorax, the drainage catheter can be removed and a
further follow-up radiograph obtained to detect recurrence. A
straight radio-opaque line is occasionally seen here along the line of
the removed tube, known as a "drain track" (fig 11). This may be
misinterpreted as a recurrent air leak, but its straight course and
precise relation to the drain position on the radiograph before
removal are usually conclusive. Presumably this finding is due to
indentation of the pleura by the drain.
 After placement of a chest drain, the tubing is connected to an
underwater seal or flutter valve. The patient usually undergoes daily
chest radiography until the pneumothorax has resolved. Care must be
taken to ensure that an unclamped chest drain bottle is not placed on
the trolley above the level of the patient's thorax during the trip to
the x ray department. This may result in accumulation of air and
fluid in the pleural space, producing a hydropneumothorax on the
radiograph. If the drain bottle is later returned to a dependent
position without the physician's knowledge, then inappropriate suction
or additional drainage procedures may be carried out. This possibility
should be considered in unexpected deterioration on radiographs,
especially in the absence of clinical signs. Questioning the patient
may be helpful. This problem can be prevented by emphasising to
nursing and portering staff the importance of the bottle position.

 Clamping of the chest drain before radiography is often carried out

to detect small air leaks. British Thoracic Society guidelines do not
generally recommend this but consider it acceptable under the
supervision of trained nursing staff in the ward environment. The
merits of clamping of the drain are, however, a matter of some
controversy among chest specialists.
 Fig 9 (top) Chest radiography shows unremarkable appearance of intercostal drain
(arrow), apart from its medial location. (bottom) Axial computed tomography shows
drain (arrow) is located in subcutaneous tissues. More superior images showed that the
drain terminated in this superficial position

 Fig 10 (top) Two large bore chest drains in a patient who developed a pneumothorax
secondary to cavitating pneumonia. Lower drain (white arrows) is satisfactorily sited,
but upper drain (open arrow) has side holes protruding into subcutaneous tissues,
leading to extensive air leak. (bottom) Small pigtail catheter inserted into basal
pneumothorax (p). Progressive traction on drain has led to extrusion of side holes into
subcutaneous tissues (open arrow) and through skin surface (white arrow)
 Fig 11 (left) Left apical chest drain (open arrow) in satisfactory position after
lobectomy. (right) Chest radiograph after removal of drain next day shows faint
radio-opaque line (arrow), known as a "drain track." This was seen to resolve on
subsequent radiographs

 Fig 12 (left) Small pneumothorax post-pleurectomy at right apex (open arrow).

Fluoroscopic guided needle puncture (white arrow) is being carried out. This unusual
approach through the first intercostal space could damage subclavian vessels, which
can be avoided by preliminary ultrasound examination of the needle path
(arrowhead=suture material). (centre) Wire (arrow) is placed through the needle
after aspiration of air. (right) Pigtail catheter coiled in pneumothorax and connected
to underwater seal
Prognosis
 The outcome of pneumothorax depends upon the extent and type of
pneumothorax. A small spontaneous pneumothorax will generally
resolve on its own without treatment. A secondary pneumothorax
associated with underlying disease, even when small, is much more
serious and carries a 15% mortality (death) rate. A secondary
pneumothorax requires urgent and immediate treatment. Having one
pneumothorax increases the risk of developing the condition again.
The recurrence rate for both primary and secondary pneumothorax
is about 40%; most recurrences occur within 1.5 to two years.

Prevention
 Most cases of collapsed lung cannot be prevented. Quitting smoking
can reduce your risk of developing the types of lung disease
associated with this problem. Wearing your seat belt in the car
and avoiding other activities that put you at risk of chest injuries
can help you to avoid a collapsed lung caused by trauma
Nursing Interventions
 Respiratory monitoring- Collection and analysis of patient data to
ensure airway patency and adequate gas exchange.
 Airway management- Facilitation of patency of air passages.
 Cough enhancement- Promotion of deep inhalation by the patient
with subsequent generation of high intrathoracic pressures and
compression of underlying lung parenchyma for the forceful expulsion
of air.
 Ventilation assistance- Promotion of an optimal spontaneous
breathing pattern that maximizes oxygen and carbon dioxide
exchange in the lungs.
 Airway sunctioning- Removal of airway secretions by inserting a
sunctions catheter into the patients.
 Nursing Evaluation(Outcomes)
Return to functional baseline status, stabilization of, or improvement
in:
 Respiratory status: Airway patency- Extent to which the
tracheobronchial passages remain open; measured on a scale of
extremely compromised to not compromised.
 Respiratory status: Gas exchange- The alveolar exchange of O2 or
CO2 to maintain arterial blood gas concentrations; measured on a scale
of extremely compromised to not compromised.
 Respiratory status: Ventilation- movement of air in and out of the
lungs; measured on a scale of extremely compromised to not
compromised.