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February 13, 1978

Status Asthmaticus, Mechanical Ventilation, and Pneumothorax

Author Affiliations

Bethesda, Md

JAMA. 1978;239(7):613. doi:10.1001/jama.1978.03280340033004

To the Editor.—  The review by Scoggin et al (238:1158, 1977) of their experience with mechanical ventilation of patients with status asthmaticus clearly demonstrates the increased incidence of certain complications (pneumothorax, pneumonia, hypoventilation, and tube malfunction). I would like to expand on the issue of pneumothoraxes in light of their discovery of two unsuspected pneumothoraxes at autopsy.As a medical housestaff officer, I was able to reverse six cardiopulmonary arrests in patients with chronic lung disease by release of a tension pneumothorax. Each of these events was thought to be a primary cardiac arrest because the initial decompensation noted was either bradycardia, ventricular tachycardia, or hypotension before a respirator alarm was triggered. Also, the physical signs of a tension pneumothorax were not detectable, as breath sounds are often severely diminished in these patients and a substantial shift in the mediastinum was not found in the circumstances of the "code."Often