Merck Manual

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Pneumothorax (Open)

(Sucking Chest Wound)

By

Thomas G. Weiser

, MD, MPH, Stanford University School of Medicine

Last full review/revision Apr 2022
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Open pneumothorax is a pneumothorax involving an unsealed opening in the chest wall; when the opening is sufficiently large, respiratory mechanics are impaired.

Some patients with traumatic pneumothorax Pneumothorax (Traumatic) Traumatic pneumothorax is air in the pleural space resulting from trauma and causing partial or complete lung collapse. Symptoms include chest pain from the causative injury and sometimes dyspnea... read more have an unsealed opening in the chest wall. When patients with an open pneumothorax inhale, the negative intrathoracic pressure generated by inspiration causes air to flow into the lungs through the trachea and simultaneously into the intrapleural space through the chest wall defect. There is little airflow through small chest wall defects and hence few adverse effects. However, when the opening in the chest wall is sufficiently large (when the defect is about two thirds the diameter of the trachea or larger), more air passes through the chest wall defect than through the trachea into the lung. Larger defects can eliminate ventilation on the affected side. Inability to ventilate the lungs causes respiratory distress and respiratory failure.

Diagnosis of Open Pneumothorax

  • Clinical evaluation

Open pneumothorax is diagnosed clinically and requires inspecting the entire chest wall surface.

Treatment of Open Pneumothorax

  • Partially occlusive dressing followed by tube thoracostomy

Immediate management of open pneumothorax is to cover the wound with a rectangular sterile occlusive dressing that is closed securely with tape on only 3 sides. Thus, the dressing prevents atmospheric air from entering the chest wall during inspiration but allows any intrapleural air out during expiration. Tube thoracostomy should be done when the patient is stabilized. The wound may require later surgical repair.

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NOTE: This is the Professional Version. CONSUMERS: Click here for the Consumer Version
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