CT-Guided catheter drainage of loculated thoracic air collections in mechanically ventilated patients with acute respiratory distress syndrome

OBJECTIVE. We report our experience with CT-guided percutaneous catheter dr ainage of loculated thoracic air collections in mechanically ventilated pat ients with acute lung injury or acute respiratory distress syndrome. MATERIALS AND METHODS. Nine critically ill patients had 17 air collections (13 pneumothoraces, three pneumatoceles, one tension pneumomediastinum) tha t either developed despite the presence of standard surgical chest tubes or were in loculated sites that were difficult to access. All nine patients w ere ventilated mechanically for a clinical diagnosis of acute respiratory d istress syndrome. Catheter size ranged from 7- to 28-French. Response was m easured by imaging follow-up, ventilatory parameters, and clinical outcome. RESULTS. On follow-up imaging studies, all 17 air collections were shown to have been evacuated successfully. Catheters remained in place for a mean o f 11 days (range, 4-28 days). No major complications occurred. Sixteen air collections were treated successfully with CT-guided catheter placement alo ne; the remaining air collection, a pneumothorax, was treated with subseque nt placement of a chest tube by the surgeon at the patient's bedside. No su rgery was undertaken for the air collections. Improvement in gas exchange w as documented by increase in the hypoxemia ratio (arterial oxygen pressure divided by the inspired fraction of oxygen) in seven of 12 drainages; the o ther drainages were accompanied either by no improvement or by deterioratio n. Eight (89%) of the nine patients eventually were extubated and discharge d from the hospital. The ninth patient died. CONCLUSION. CT-guided percutaneous catheter drainage provided effective tre atment for loculated thoracic air collections and obviated surgical interve ntion in these critically ill, high-surgical-risk patients.