Risk of Pneumothorax in Long-term Domiciliary NIV – Management Strategies and Risk Stratification, a case Study.

Introduction: Pneumothorax, although uncommon, is a well-documented risk of domiciliary NIV in COPD patients particularly those with emphysema or bullous disease. Despite this, risk stratification for pneumothorax in patients using domiciliary NIV remains underexplored Aims and Objectives: This case explores whether pre-emptive risk stratification, based on CT Findings, could have predicted pneumothorax in a patient with COPD on long-term NIV. We report an 80-year-old who developed recurrent pneumothoraces, initially managed conservatively, later requiring chest drainage and pressure adjustment on different occasions. The study aims to highlight the importance of recognising high-risk features before initiating or continuing NIV, to guide ventilator settings and monitoring, thus improving outcomes and reducing risks of complications Methods: Retrospective review was conducted, encompassing clinical records, NIV settings and scans Results: HRCT showed extensive emphysematous changes with multiple blebs and bullae. He first presented with a symptomatic left-sided pneumothorax, which improved with conservative management and temporarily discontinuing NIV. Following resolution, NIV was resumed. He later presented with type 2 respiratory failure due to a right-sided pneumothorax, requiring chest drainage. Following this, NIV resumed at reduced pressures after a brief cessation Conclusion: This case underscores the need for risk stratification in long-term NIV, especially in emphysematous patients. HRCT may help identify high-risk individuals. Careful monitoring, lower pressures, and temporary NIV cessation may help manage risk and improve outcomes, further studies are needed for guidance