Pneumothorax (PNX) is a recognized cause of preventable deaths in trauma patients. Our objective was to determine the incidence of traumatic PNX, the characteristics of its victims, and the treatment they receive. The study consisted of data set of a population-based study on major trauma. The incidence of PNX was 81 per 1 million population per year, mostly caused by transport accidents. PNX victims generally had multiple injuries, and they showed on-scene clinical parameters worse than victims of other chest injuries of comparable severity. Fifty-three percent of PNXs were drained during the prehospital and early (< 2 hours) hospital course. There was no uniformity of treatment among different types of rescue facilities, some of them never performing decompression despite clinical need. The z statistic for mortality was −0.63. PNX can be expected in one in five major trauma victims found alive. PNX is associated with a peculiar on-scene instability. Early decompression is often required. The effects of wider access to prehospital decompression and the reasons for its uneven availability in our setting need elucidation. Nevertheless, the present mortality follows the international standards.

Introduction.Noninvasive blood pressure (NIBP) monitoring methods are widely used in critically ill patients despite poor evidence of their accuracy. The erroneous interpretations of blood pressure (BP) may lead to clinical errors.Objectives.To test the accuracy and reliability of aneroid (ABP) and oscillometric (OBP) devices compared to the invasive BP (IBP) monitoring in an ICU population.Materials and Methods.Fifty adult patients (200 comparisons) were included in a randomized crossover trial. BP was recorded simultaneously by IBP and either by ABP or by OBP, taking IBP as gold standard.Results.Compared with ABP, IBP systolic values were significantly higher (mean difference ± standard deviation9.74±13.8;P<0.0001). Both diastolic (-5.13±7.1;P<0.0001) and mean (-2.14±7.1;P=0.0033) IBP were instead lower. Compared with OBP, systolic (10.80±14.9;P<0.0001) and mean (5.36±7.1;P<0.0001) IBP were higher, while diastolic IBP (-3.62±6.0;P<0.0001) was lower. Bland-Altman plots showed wide limits of agreement in both NIBP-IBP comparisons.Conclusions.BP measurements with different devices produced significantly different results. Since in critically ill patients the importance of BP readings is often crucial, noninvasive techniques cannot be regarded as reliable alternatives to direct measurements.