Complications during in-hospital chest tube drainage for iatrogenic pneumothorax: A retrospective study on complication type, incidence and management.

<bold>Background:</bold> Iatrogenic pneumothorax occurs frequently after diagnostic and therapeutic pulmonary, and management may contrast spontaneous pneumothorax due to different lung function, age, comorbidity, and frailty in populations. If the favourable safety profile in spontaneous primary pneumothorax, which allows outpatient care, is comparable in iatrogenic pneumothorax in not known. Our objective was to study the safety of iatrogenic pneumothorax treated with chest tubes and to identify the risks of life-threatening events. <bold>Methods:</bold> In a retrospective cohort of patients admitted and treated with an adhesive valve-integrated chest tube system, we recorded the incidence of complications. The primary outcome was the incidence of life-threatening events that required urgent medical action. <bold>Results:</bold> In 99 patients, 6 (6%) life-threatening events occurred. The incidence was 21% in patients with saturation before biopsy below 95% and 1% in patients with saturation above 95%, p=0.003, and greater if the lung had not expanded on the first radiograph, 25%, after insertion of the chest tube, than if the lung had fully expanded, 4%, or partially expanded, 2%, p=0.009. OR was 20 (95%CI 2.1 – 176) for saturation and OR 8 (95%CI 0.8 – 80.4) for initial response but not significant when adjusted for age, sex, and FEV1. <bold>Conclusions:</bold> The incidence of life-threatening events during chest tube-treated iatrogenic pneumothorax is significant, but acceptable in patients without impaired lung function prior to the procedure and early response to treatment.