Pneumothorax and insertion of a chest drain

Safe management of pneumothorax (air in the pleural space) requires an understanding of the intrapleural pathophysiology. The lungs are enveloped by the visceral pleura which, at the hilum, become continuous with the fibrous parietal pleura covering the mediastinum, diaphragm and inner wall of the chest. The parietal and visceral pleura are separated by the narrow, fluid-filled pleural space. The lungs are elastic and therefore have a tendency to recoil from the chest wall, so at rest the intrapleural pressure is less than atmospheric pressure (-0.3 kPa). This negative pressure keeps the pleural layers in contact and stops the lung collapsing.