Following current guidelines, spontaneous pneumothorax should be primarily managed with minimal invasive strategies. In real-world clinical practice, oxygen supplementation regardless of the presence or absence of hypoxemia is frequently applied in patients with a pneumothorax, with the intention to enhance the resorption rate of air from the pleural cavity (“nitrogen wash-out theory”). This review provides an overview of the scientific origin of this practice in animal models, and its clinical use in adult and paediatric patients. Clinical studies from PubMed, Embase and Cochrane library were reviewed by the authors using the keywords, “oxygen AND pneumothorax”, “nitrogen washout AND pneumothorax” and “nitrogen AND pneumothorax”, and recommendations from current guidelines were also reviewed by the authors. A selected total of nine clinical studies and three guidelines were included. Though in animal models there appears to be a therapeutic effect of oxygen therapy for the treatment of pneumothorax, clinical data in patient populations mainly stem from retrospective studies, mostly with a small sample size and inadequate study design. We recommend conducting prospective clinical studies with adequate methodology to address the question of whether or not oxygen therapy should be used to treat pneumothorax, regardless of the presence or absence of hypoxemia.

We present a case of 43-year-old male patient with broadly by Omalizumab, Mepolizumab and Benralizumab pretreated allergic asthma, who suffered a near fatal exacerbation, triggered by an influenza A infection. Due to massive bronchoconstriction with consecutive hypercapnic ventilatory failure veno-venous ECMO therapy had to be implemented. Hence, guideline directed asthma therapy a substantial bronchodilatation could not be achieved. After administration of a single dose Tezepelumab, a novel TLSP-inhibitor, and otherwise unchanged therapy we documented a significant reduction in intrinsic PEEP measured via a naso-gastric balloon catheter and a narrowing in the expiratory flow curve of the ventilator within 24 hours. The consecutive ventilatory improvement allowed the successful weaning from veno-venous ECMO therapy and invasive ventilation.

Because of the initially urgent need for treatments for COVID-19-associated acute respiratory distress syndrome (ARDS), the efficacy and tolerability of inhaled solnatide, a direct activator of the epithelial sodium channel (ENaC) under clinical investigation for the treatment of ARDS, were assessed in a pilot trial. This randomized controlled double-blind clinical trial was performed at two study centers in Vienna, Austria. Adult mechanically ventilated patients with moderate to severe ARDS (Berlin Definition) caused by COVID-19 were randomized 1:1 to inhalation of solnatide (100 mg) or placebo twice daily for seven days. The primary outcome parameter was ventilator-free days (VFDs) within 28 days; survival was assessed at 28 and 60 days as a secondary outcome. A total of 30 out of the 40 planned patients were included, 15 randomized to solnatide and 15 to placebo. Then the trial was stopped early due to slow recruitment. The median VFDs were 0 in both groups (p = 0.653). Twenty out of 30 patients (66.7%) survived until day 28 [solnatide group: n = 11 (73.3%), placebo group: n = 9 (60%)]. One additional patient per group died until day 60. In total, 41 adverse events (AEs) and 10 serious AEs occurred in the solnatide group, and 26 AEs and 14 serious AEs in the placebo group. No AE was considered to be related to the study treatment. There was no difference in VFDs or survival between the solnatide and the placebo group. Solnatide appeared safe in this limited cohort of critically ill patients with COVID-19. EU clinical trials register, EudraCT number 2020-001244-26.