27th May 2025

An 87-year-old gentleman with known severe COPD is currently being treated for an infective exacerbation of COPD secondary to COVID-19 infection.

An 87-year-old gentleman with known severe COPD is currently being treated for an infective exacerbation of COPD secondary to COVID-19 infection. He becomes suddenly short of breath and hypoxic in the night with evidence of respiratory distress. His observations are respiratory rate 36 breaths/ min, oxygen saturations 83% on 15L via non re-breathe, blood pressure 85/43mmHg and HR 143bpm. On examination, trachea is deviated to the right with reduced air entry throughout on the left. 

Investigations: 

Chest x-ray: Large pneumothorax on the left. Trachea and mediastinum shifted to the right.

What is the most appropriate management strategy for this patient? 

Select the SINGLE most appropriate option from the list below. Select ONE option only.