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Man, 33 years old, with a history of prior treatment for pulmonary tuberculosis with significant sequelae and a crack user.

👉 Admitted intubated due to respiratory failure and probable pneumonia.

👉 Developed a spontaneous tension pneumothorax.

🧐 Despite chest drainage with a water-seal system, the left lung did not expand properly, as seen in the chest X-rays below:

🧐 The drainage system showed bubbling during both the inspiratory and expiratory phases.
🤔 Questions:

1. What do you think should be done in this case?
2. What is the best way to adjust mechanical ventilation?