101
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Gerhardy BC, Liebenberg P, Simpson G. Conservative management of traumatic pneumothoraces: A retrospective cohort study. Emerg Med Australas 2021; 34:194-198. [PMID: 34433229 DOI: 10.1111/1742-6723.13846] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 08/02/2021] [Accepted: 08/04/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Traumatic pneumothoraces (T-PTXs) are traditionally managed with an intercostal catheter (ICC), despite little evidence for this. Success with conservative management of primary spontaneous PTX has been demonstrated, and our ED has adopted a conservative approach where safe for all PTX. METHODS We reviewed all T-PTXs at our institution over a 7-year period to assess outcomes of those conservatively managed and compare with those who received an ICC. A total of 144 cases were identified, 65 managed conservatively and 79 invasively. Each was individually reviewed and variables including demographics, aetiology, smoking/lung disease history, T-PTX size (apical interpleural distance and hemithorax percentage), length of stay, Revised Trauma Score, Injury Severity Score and delayed intervention/complications were recorded. Chi-squared, Z-score, Mann-Whitney U and t-tests were used for analysis. RESULTS The mean apical interpleural distance was 26.8 mm (95% confidence interval [CI] 22.1-29.7 mm) in the conservative group and 49.1 mm (95% CI 41.2-57.0 mm) in the ICC group (P < 0.05 for difference between groups). Mean T-PTX percentage 25.9% (95% CI 22.1-29.7%) in the conservative group versus 45.9% (95% CI 39.7-50.5%) in the ICC group (P < 0.05 for difference between two groups) and mean Revised Trauma Score 7.4 (conservative) versus 6.8 (invasive) (P < 0.05). No conservatively managed patient required a delayed intervention for their T-PTX, and 2 of 79 (3%) patients in the ICC group had a complication (one infection, one haemothorax). CONCLUSION Our data support conservative management of selected T-PTXs and shows a need for a prospective randomised trial to further examine this intervention.
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102
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Hein S, Kappes J. [Update on primary spontaneous pneumothorax - conservative or primarily surgical therapy?]. Dtsch Med Wochenschr 2021; 146:994-997. [PMID: 34344027 DOI: 10.1055/a-1272-9512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Spontaneous pneumothorax is a potentially life-threatening situation. Therefore, it is mandatory to treat it safely. The incidence is approximately 10 out of 100 000 residents per year. It occurs through an immediate disruption of the visceral pleura that results in an accumulation of air in the pleural space. According to its etiology, spontaneous pneumothorax is divided into 2 groups. Whereas primary spontaneous pneumothorax occurs in healthy individuals without any detectable lung disease, secondary spontaneous pneumothorax occurs in patients with preexisting. Diagnosis of pneumothorax is typically made by chest x-ray. After diagnosis pneumothorax is traditionally treated by an insertion of a thoracic tube.Recently, thoracic ultrasound gained influence in diagnosis of pneumothorax and primarily conservative treatment strategies have been shown to be safe and equally effective in particular groups of patients. This article aims to present and discuss these upcoming strategies.
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Affiliation(s)
- Selina Hein
- Katholisches Klinikum Koblenz-Montabaur, Klinik für Innere Medizin/Pneumologie, Schlaf- und Beatmungsmedizin Koblenz
| | - Jutta Kappes
- Katholisches Klinikum Koblenz-Montabaur, Klinik für Innere Medizin/Pneumologie, Schlaf- und Beatmungsmedizin Koblenz
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103
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Cortes‐Telles A, Ortíz‐Farias DL, Perez‐Hernandez F, Rodriguez‐Morejon D. Secondary spontaneous pneumothorax: a time to re-evaluate management. Respirol Case Rep 2021; 9:e00749. [PMID: 34262774 PMCID: PMC8267824 DOI: 10.1002/rcr2.749] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 03/22/2021] [Accepted: 03/27/2021] [Indexed: 11/24/2022] Open
Abstract
Spontaneous pneumothorax (SP) is defined as the presence of air in the pleural cavity and remains a significant health problem. Secondary SP (SSP) is associated with underlying lung diseases, such as cystic fibrosis, chronic obstructive pulmonary disease (COPD), and interstitial lung disease (ILD), and is associated with poor outcomes. The current guidelines in the management of SSP have not been updated since the last decade; therefore, new protocols focused on the management of SSP should be evaluated. We present two cases of patients admitted with SSP who were treated conservatively due to haemodynamic stability. In both cases, the pneumothoraces resolved without further complications.
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Affiliation(s)
- Arturo Cortes‐Telles
- Respiratory and Thoracic DepartmentHospital Regional de Alta Especialidad de la Península de YucatanMéridaYucatán97130Mexico
| | - Diana Lizbeth Ortíz‐Farias
- Respiratory and Thoracic DepartmentHospital Regional de Alta Especialidad de la Península de YucatanMéridaYucatán97130Mexico
| | - Felipe Perez‐Hernandez
- Respiratory and Thoracic DepartmentHospital Regional de Alta Especialidad de la Península de YucatanMéridaYucatán97130Mexico
| | - Dulce Rodriguez‐Morejon
- Respiratory and Thoracic DepartmentHospital Regional de Alta Especialidad de la Península de YucatanMéridaYucatán97130Mexico
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104
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Lee JH, Hong H, Tamburrini M, Park CM. Percutaneous transthoracic catheter drainage for lung abscess: a systematic review and meta-analysis. Eur Radiol 2021; 32:1184-1194. [PMID: 34327579 DOI: 10.1007/s00330-021-08149-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 06/09/2021] [Accepted: 06/16/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To evaluate the outcomes of patients receiving image-guided percutaneous catheter drainage (PCD) for lung abscesses in terms of treatment success, major complications, and mortality as well as the predictors of those outcomes. METHODS Embase and OVID-MEDLINE databases were searched to identify studies on lung abscesses treated with PCD that had extractable outcomes. The outcomes were pooled using a random-intercept logistic regression model. Multivariate Firth's bias-reduced penalised-likelihood logistic regression analyses were performed to identify predictors of treatment success and complications. Methodological quality was assessed by summing scores of binary responses to items regarding selection, ascertainment of exposure and outcome, causality of follow-up duration, and reporting. RESULTS From 26 studies with acceptable methodological quality (median score, 4; range, 3-5), 194 patients were included. The pooled rates of treatment success and major complications were 86.5% (95% confidence interval [CI], 78.5-91.8%; I2 = 23%) and 8.1% (95% CI, 4.1-15.3%; I2 = 26%), respectively. Four patients eventually died from uncontrolled lung abscesses (pooled rate, 1.5%; 95% CI, 0.2-11.1%; I2 = 36%). Malignancy-related abscess (odds ratio [OR], 0.129; 95% CI, 0.024-0.724; p = .022) and the occurrence of a major complication (OR, 0.065; 95% CI, 0.02-0.193; p < .001) were significant predictors of treatment failure. Traversing normal lung parenchyma was the only significant risk factor for major complications (OR, 27.69; 95% CI, 7.196-123.603; p < .001). CONCLUSION PCD under imaging guidance was effective for lung abscess treatment, with a low complication rate. Traversal of normal lung parenchyma was the sole risk factor for complications, and malignancy-related abscesses and the occurrence of major complications were predictors of treatment failure. KEY POINTS • The pooled treatment success rate of PCD for lung abscess was reasonably high (86.5%); malignancy-related abscesses and the occurrence of a major complication were predictors of treatment failure. • The pooled rate of percutaneous transthoracic catheter drainage-related major complications was 8.1% and traversing normal lung parenchyma by the catheter was the only risk factor. • The pooled mortality rate from uncontrolled lung abscesses with percutaneous transthoracic catheter drainage was low.
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Affiliation(s)
- Jong Hyuk Lee
- Department of Radiology and Institute of Radiation Medicine, Seoul National University College of Medicine, Jongno-gu, Seoul, 03080, Korea
| | - Hyunsook Hong
- Medical Research Collaborating Center, Seoul National University Hospital, Seoul, Korea
| | - Mario Tamburrini
- Pulmonology Unit, General Hospital of Pordenone, Pordenone, Italy
| | - Chang Min Park
- Department of Radiology and Institute of Radiation Medicine, Seoul National University College of Medicine, Jongno-gu, Seoul, 03080, Korea.
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105
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Aujayeb A. Ambulatory pneumothorax management in a district general hospital. J R Coll Physicians Edinb 2021; 51:125-128. [PMID: 34131666 DOI: 10.4997/jrcpe.2021.205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The pleural vent (PV) is a new drain and valve device enabling ambulatory pneumothorax management. This study analysed the characteristics and outcomes of patients with pneumothorax treated with a PV. METHODS The characteristics and outcomes of 49 patients with pneumothorax treated with a PV between 1 March 2018 and 1 February 2021 were retrospectively analysed. RESULTS The mean number of days the PV remained in situ for all patients was 5.6 days, range 0-25, IQR 3-7. Forty patients were managed completely in the ambulatory setting. The total number of days with the PVs in situ was 248. Approximate inpatient bed days saved are 240-320 days. Complications requiring a change in management occurred in nine (18.3%) cases. CONCLUSION This single-centre study shows that ambulatory pneumothorax management with the PV is feasible and associated with inpatient bed savings. Complication rates are less than previously described.
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Affiliation(s)
- Avinas Aujayeb
- Northumbria Healthcare NHS Foundation Trust, Northumbria Way, Cramlington, Northumberland NE23 6NZ, UK,
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106
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Duffy A, Ward J, Malvika B, Aujayeb A. Ambulatory management of primary spontaneous pneumothorax. Breathe (Sheff) 2021; 17:200342. [PMID: 34295420 PMCID: PMC8291907 DOI: 10.1183/20734735.0342-2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 03/21/2021] [Indexed: 12/04/2022] Open
Abstract
The management of primary spontaneous pneumothorax (PSP) is currently being debated. The British Thoracic Society (BTS) guidelines [1] are over a decade old and recent European Respiratory Society (ERS) guidance [2] summarises more up-to-date evidence. Needle aspiration, intercostal drain insertion (ICD) and observation are all advocated. Ambulatory pneumothorax management has been described for decades [3]. A systematic review of underpowered and nonrandomised trials suggested a need for high quality data to support the use of ambulatory devices in pneumothorax management [3]. Thus, the Randomised Ambulatory Management of Primary Pneumothorax (RAMPP) trial was devised [4]. The trial aimed to compare the length of hospitalisation and safety of ambulatory management with standard care (needle aspiration±ICD insertion) [5]. We aim to describe the outcomes of RAMPP. We discuss its general relevance and in the context of the recent trial favouring conservative management over an interventional approach in PSP [6]. Ambulatory pneumothorax management in primary spontaneous pneumothorax is safe and feasiblehttps://bit.ly/39w3EfD
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Affiliation(s)
- Aleksandra Duffy
- Respiratory Dept, Freeman Hospital, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Janice Ward
- Respiratory Dept, Northumbria Healthcare NHS Foundation Trust, Newcastle upon Tyne, UK
| | | | - Avinash Aujayeb
- Respiratory Dept, Northumbria Healthcare NHS Foundation Trust, Newcastle upon Tyne, UK
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107
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Brenac S. Requirement of interventional treatment in a patient being conservatively managed for persistent pneumothorax over a prolonged period. BMJ Case Rep 2021; 14:e243556. [PMID: 34244201 PMCID: PMC8268899 DOI: 10.1136/bcr-2021-243556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2021] [Indexed: 11/03/2022] Open
Abstract
An 85-year-old ex-smoker being managed conservatively over 2 years for a small right apical pneumothorax presented to the respiratory clinic with suddenly worsening shortness of breath and chest pain. A chest radiograph demonstrated sudden deterioration in the size of his pneumothorax. Previous CT scans had found emphysematous cystic changes within the lungs, and his new presentation warranted definitive surgical intervention with a right bullectomy and talc pleurodesis through a video-assisted thoracoscopic surgery procedure. The patient made a good recovery and was discharged from clinic a year later. This case demonstrates the importance of follow-up in patients with unresolved pneumothoraces due to the potential for sudden deterioration, and highlights the significance of respecting patient involvement and autonomy in the decision-making process.
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Affiliation(s)
- Sophia Brenac
- Department of Respiratory Medicine, Shrewsbury and Telford Hospitals NHS Trust, Telford, Shropshire, UK
- Keele University School of Medicine, Keele, Staffordshire, UK
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108
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Mummadi SR, Porcel JM. Ambulatory management of secondary spontaneous pneumothorax: a mirage, or a solution on the horizon? Eur Respir J 2021; 57:57/6/2100003. [PMID: 34168055 DOI: 10.1183/13993003.00003-2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Accepted: 01/04/2021] [Indexed: 11/05/2022]
Affiliation(s)
| | - José M Porcel
- Pleural Medicine Unit, Dept of Internal Medicine, Arnau de Vilanova University Hospital, IRBLleida, University of Lleida, Lleida, Spain
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109
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Wilson PM, Rymeski B, Xu X, Hardie W. An evidence-based review of primary spontaneous pneumothorax in the adolescent population. J Am Coll Emerg Physicians Open 2021; 2:e12449. [PMID: 34179877 PMCID: PMC8212556 DOI: 10.1002/emp2.12449] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 04/16/2021] [Accepted: 04/20/2021] [Indexed: 02/03/2023] Open
Abstract
Primary spontaneous pneumothorax (PSP) is a relatively common problem in emergency medicine. The incidence of PSP peaks in adolescence and is most common in tall, thin males. Recent advances in the care of patients with PSP have called into question traditional approaches to management. This clinical review highlights the changing management strategies for PSP and concludes with a proposed evidence-based pathway to guide the care of adolescents with PSP.
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Affiliation(s)
- Paria M. Wilson
- Department of PediatricsUniversity of CincinnatiCollege of MedicineCincinnatiOhioUSA
- Division of Emergency MedicineCincinnati Children's Hospital Medical CenterCincinnatiOhioUSA
| | - Beth Rymeski
- Division of Pediatric SurgeryCincinnati Children's Hospital Medical CenterCincinnatiOhioUSA
| | - Xuefeng Xu
- Department of RheumatologyImmunology & AllergyRespiratory MedicineThe Children's HospitalZhejiang University School of MedicineNational Clinical Research Center for Child HealthHangzhouChina
| | - William Hardie
- Department of PediatricsUniversity of CincinnatiCollege of MedicineCincinnatiOhioUSA
- Division of Pulmonary MedicineCincinnati Children's Hospital Medical CenterCincinnatiOhioUSA
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110
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Mummadi SR, Stoller JK, Lopez R, Kailasam K, Gillespie C, Hahn PY. Epidemiology of Adult Pleural Disease in the United States. Chest 2021; 160:1534-1551. [PMID: 34023322 DOI: 10.1016/j.chest.2021.05.026] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 04/27/2021] [Accepted: 05/10/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Comprehensive US epidemiologic data for adult pleural disease are not available. RESEARCH QUESTION What are the epidemiologic measures related to adult pleural disease in the United States? STUDY DESIGN AND METHODS Retrospective cohort study using Healthcare Utilization Project databases (2007-2016). Adults (≥ 18 years of age) with malignant pleural mesothelioma, malignant pleural effusion, nonmalignant pleural effusion, empyema, primary and secondary spontaneous pneumothorax, iatrogenic pneumothorax, and pleural TB were studied. RESULTS In 2016, ED treat-and-discharge (T&D) visits totaled 42,215, accounting for charges of $286.7 million. In 2016, a total of 361,270 hospitalizations occurred, resulting in national costs of $10.1 billion. A total of 64,174 readmissions contributed $1.16 billion in additional national costs. Nonmalignant pleural effusion constituted 85.5% of ED T&D visits, 63.5% of hospitalizations, and 66.3% of 30-day readmissions. Contemporary sex distribution (male to female ratio) in primary spontaneous pneumothorax (2.1:1) differs from older estimates (6.2:1). Decadal analyses of annual hospitalization rates/100,000 adult population (2007 vs 2016) showed a significant (P < .001) decrease for malignant pleural mesothelioma (1.3 vs 1.09, respectively), malignant pleural effusion (33.4 vs 31.9, respectively), iatrogenic pneumothorax (17.9 vs 13.9, respectively), and pleural TB (0.20 vs 0.09, respectively) and an increase for empyema (8.1 vs 11.1, respectively) and nonmalignant pleural effusion (78.1 vs 100.1, respectively). Empyema hospitalizations have high costs per case ($38,591) and length of stay (13.8 days). The mean proportion of readmissions attributed to a pleural cause varied widely: malignant pleural mesothelioma, 49%; malignant pleural effusion, 45%; nonmalignant pleural effusion, 31%; empyema, 27%; primary spontaneous pneumothorax, 27%; secondary spontaneous pneumothorax, 27%; and iatrogenic pneumothorax, 20%. INTERPRETATION Significant epidemiologic trends and changes in various pleural disease were observed. The analysis identifies multiple opportunities for improvement in management of pleural disease.
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Affiliation(s)
| | - James K Stoller
- Education Institute, Cleveland Clinic Foundation, Cleveland, OH
| | - Rocio Lopez
- Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, OH
| | - Karthik Kailasam
- Community Care Institute, Cleveland Clinic Foundation, Cleveland, OH
| | - Colin Gillespie
- Respiratory Institute, Cleveland Clinic Foundation, Cleveland, OH
| | - Peter Y Hahn
- Department of Pulmonary and Critical Care, Metro Health-University of Michigan Health, Wyoming, MI
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111
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Ashkenazi M, Bak A, Sarouk I, Bar Aluma BE, Dagan A, Bezalel Y, Vilozni D, Efrati O. Spontaneous pneumothorax-When do we need to intervene? CLINICAL RESPIRATORY JOURNAL 2021; 15:967-972. [PMID: 33998780 DOI: 10.1111/crj.13400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 05/02/2021] [Accepted: 05/04/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Pneumothorax can be classified as traumatic, iatrogenic or spontaneous (SP), which can be subdivided into primary spontaneous pneumothorax (PSP), a condition without preexisting lung disease, or secondary spontaneous pneumothorax (SSP) a complication of a preexisting lung disease. Recurrence rate of PSP is 30% whereas for SSP rate is unknown. This article explores the experience of a tertiary center over 20 years. METHODS A retrospective case review of patients hospitalized with pneumothorax to investigate the natural history and treatment of SP in a young population in a single tertiary center was conducted. A search of the digital archive (going back to 01/01/1995) of Sheba Medical Center identified hospitalized patients below the age of 40. RESULTS The database was composed of the records of 750 patients (612 males, 138 females) who were hospitalized. The recurrence risk for SP after nonoperative treatment was significantly higher. Women were found to have an increased risk of SSP when having SP (OR 2.78). Asthma was the most prevalent disease causing SSP in young people. CONCLUSIONS In this large cohort, we found that operative procedure has clear protective effect from recurrence in SP, so surgery should be positively considered when treating SP in hospitalized patients. Among young people and particularly in pediatric patients, when females have a SP, we strongly recommend looking for primary lung disease. More studies are needed to determine the risk factors and produce clear guidelines regarding surgery as first treatment.
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Affiliation(s)
- Moshe Ashkenazi
- Pediatric Pulmonology and National CF Center, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel-Hashomer, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Alon Bak
- Pediatric Pulmonology and National CF Center, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel-Hashomer, Israel
| | - Ifat Sarouk
- Pediatric Pulmonology and National CF Center, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel-Hashomer, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Bat El Bar Aluma
- Pediatric Pulmonology and National CF Center, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel-Hashomer, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Adi Dagan
- Pediatric Pulmonology and National CF Center, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel-Hashomer, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Yael Bezalel
- Pediatric Pulmonology and National CF Center, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel-Hashomer, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Daphna Vilozni
- Pediatric Pulmonology and National CF Center, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel-Hashomer, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ori Efrati
- Pediatric Pulmonology and National CF Center, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel-Hashomer, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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112
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Gerhardy BC, Simpson G. Conservative versus invasive management of secondary spontaneous pneumothorax: a retrospective cohort study. Acute Med Surg 2021; 8:e663. [PMID: 33976898 PMCID: PMC8103887 DOI: 10.1002/ams2.663] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 04/08/2021] [Accepted: 04/16/2021] [Indexed: 11/26/2022] Open
Abstract
Aim Hospitalization, often with intervention, is the recommended management algorithm by multiple international respiratory societies for management of a secondary spontaneous pneumothorax (SSP). Over recent years we adopted a conservative approach to SSPs. We undertook a retrospective cohort study of SSP to establish the safety profile of a conservative approach for these previously unstudied patients. Methods We reviewed all cases of SSP presenting to our institution from 2012 to 2019 using the 2010 British Thoracic Society definition of an SSP. Age, gender, smoking status, underlying lung disease, pneumothorax size estimate (using the Collins method), nature of intervention, inpatient duration, and any additional complications were recorded. The χ2‐test and Mann–Whitney U‐test were used for comparison of categorical variables and categorical/continuous variables, respectively. Results Eighty‐two cases were included in the final analysis. Of them, 64 had an interpleural distance at the hilum of 1cm or greater, meeting British Thoracic Society criteria for a pleural intervention. Of these 64 patients, 25 (39%) were managed conservatively. No patient managed conservatively required a subsequent intervention. When stratified for conservative or invasive management, there was no significant difference in age, gender, smoking status, or presence of underlying lung disease between the groups. There was a significant difference in size of the pneumothorax with conservative management having smaller pneumothoraces (37% versus 54%, P < 0.001) and a shorter inpatient stay (conservative, 7.9 days; intercostal catheter, 9 days; P = 0.004). Conclusion We have demonstrated success with conservative management of SSPs where a significant proportion of them met accepted criteria for a pleural intervention.
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Affiliation(s)
| | - Graham Simpson
- Department of Respiratory Medicine Cairns Hospital Cairns QLD Australia
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113
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Muller ME, Daccord C, Taffé P, Lazor R. Prevalence of Birt-Hogg-Dubé Syndrome Determined Through Epidemiological Data on Spontaneous Pneumothorax and Bayes Theorem. Front Med (Lausanne) 2021; 8:631168. [PMID: 33987191 PMCID: PMC8111214 DOI: 10.3389/fmed.2021.631168] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 03/15/2021] [Indexed: 12/30/2022] Open
Abstract
Background: Birt-Hogg-Dubé syndrome (BHD) is a rare inherited disorder characterized by cutaneous fibrofolliculomas, multiple pulmonary cysts, recurrent spontaneous pneumothorax (SP), and renal tumors. More than 40 years after its description, the prevalence of BHD in the general population remains unknown. This study aimed at determining the prevalence of BHD by applying the Bayes theorem of conditional probability to epidemiological data on SP. Methods: We performed a meta-analysis of published data on: (1) the probability of having BHD among patients with apparent primary SP (4 studies), (2) the incidence rate of primary SP in the general population (9 studies), and (3) the probability of experiencing a SP in BHD (16 studies). Results were corrected for SP relapses, stratified by gender and year of study publication (before and after 2000), and computed with the Bayes equation. Results: The probability of having BHD among patients with apparent primary SP was 0.09 (95% confidence interval: 0.07, 0.11) or 9%. It was 0.20 (0.14, 0.27) in women and 0.05 (0.04, 0.07) in men. The incidence rate of primary SP in the general population was 8.69 (6.58, 11.46) per 100,000 person-years (p-y). It was 3.44 (2.36, 4.99) per 100,000 p-y in women and 13.96 (10.72, 18.18) per 100,000 p-y in men, and was about 2 times higher in studies published after 2000 than in those published before 2000. The probability of experiencing at least one SP among patients with BHD was 0.43 (0.31, 0.54) or 43%, without gender difference. By combining these data in the Bayes equation, we found a prevalence of BHD in the general population of 1.86 (1.16, 3.00) per million, with values of 1.86 (1.02, 3.39) per million in men, and 1.88 (0.97, 3.63) per million in women. Conclusion: The prevalence of BHD in the general population is about 2 cases per million, without difference between genders.
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Affiliation(s)
- Marie-Eve Muller
- Respiratory Medicine Department, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Cécile Daccord
- Respiratory Medicine Department, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Patrick Taffé
- University Center for Primary Care and Public Health (Unisanté), DFRI/Division of Biostatistics, University of Lausanne, Lausanne, Switzerland
| | - Romain Lazor
- Respiratory Medicine Department, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
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114
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Commentary: Tube or no tube? J Thorac Cardiovasc Surg 2021; 162:1434-1435. [PMID: 33896605 DOI: 10.1016/j.jtcvs.2021.03.087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 03/22/2021] [Accepted: 03/23/2021] [Indexed: 11/20/2022]
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115
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Louw EH, Shaw JA, Koegelenberg CFN. New insights into spontaneous pneumothorax: A review. Afr J Thorac Crit Care Med 2021; 27:10.7196/AJTCCM.2021.v27i1.054. [PMID: 34240041 PMCID: PMC8203058 DOI: 10.7196/ajtccm.2021.v27i1.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2020] [Indexed: 11/15/2022] Open
Abstract
A spontaneous pneumothorax is a pneumothorax that does not arise from trauma or an iatrogenic cause. Although the traditional classification of either primary or secondary spontaneous pneumothorax based on the absence or presence of overt underlying lung disease is still widely used, it is now well recognised that primary spontaneous pneumothorax is associated with underlying pleuropulmonary disease. Current evidence indicates that computed tomography screening for underlying disease should be considered in patients who present with spontaneous pneumothorax. Recent evidence suggests that conservative management has similar recurrence rates, less complications and shorter hospital stay compared with invasive interventions, even in large primary spontaneous pneumothoraces of >50%. A more conservative approach which is based on clinical assessment rather than pneumothorax size can thus be followed during the acute management in selected stable patients. The purpose of this review is to revisit the aetiology of spontaneous pneumothorax, identify which patients should be investigated for secondary causes and to give an overview of the management strategies at initial presentation as well as secondary prevention.
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Affiliation(s)
- E H Louw
- Division of Pulmonology, Department of Medicine, Stellenbosch University and Tygerberg Academic Hospital, Cape Town, South Africa
| | - J A Shaw
- Division of Pulmonology, Department of Medicine, Stellenbosch University and Tygerberg Academic Hospital, Cape Town, South Africa
| | - C F N Koegelenberg
- Division of Pulmonology, Department of Medicine, Stellenbosch University and Tygerberg Academic Hospital, Cape Town, South Africa
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116
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Burt BM. Commentary: Expert deconstruction: A novel peer-reviewed formula for clinical trial interpretation. J Thorac Cardiovasc Surg 2021; 162:1433-1434. [PMID: 33832789 DOI: 10.1016/j.jtcvs.2021.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 03/03/2021] [Accepted: 03/04/2021] [Indexed: 10/22/2022]
Affiliation(s)
- Bryan M Burt
- Division of General Thoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex.
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117
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The Natural History and Treatment of Cardiac Implantable Electronic Device Associated Pneumothorax-A 10-Year Single-Centre Experience. CJC Open 2021; 3:176-181. [PMID: 33644731 PMCID: PMC7893186 DOI: 10.1016/j.cjco.2020.10.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 10/15/2020] [Indexed: 11/20/2022] Open
Abstract
Background Pneumothorax is a common complication of cardiac implantable electronic device (CIED) procedures. There is a paucity of data on the natural history and management of a CIED-associated pneumothorax. Methods This is a single-centre retrospective study of all consecutive patients with a CIED-associated pneumothorax between March 2010 and March 2020. Pneumothorax size was determined on all chest x-rays after device implantation and before chest tube insertion (if placed). Changes in pneumothorax size on serial chest x-rays were reported. Clinical outcomes in patients with a severe-sized pneumothorax treated with a chest tube were compared with those treated conservatively. Results A total of 86 CIED-associated pneumothoraxes were identified, with 55 (63.9%) patients having a pneumothorax severe in size. Thirty-seven patients with a severe pneumothorax received a chest tube, whereas 18 were managed conservatively. Chest tube use was associated with a higher rate of admission to hospital (100% vs 63%, P = 0.02) for patients undergoing outpatient procedure, longer length of stay (6.3 ± 3.9 vs 2.7 ± 2.9 days, P = 0.04), but fewer chest x-rays (1.9 ± 0.7 vs 4.1 ± 2.5, P = 0.002). Conclusion An initial strategy of conservative management of a CIED-associated pneumothorax in select patients may be feasible and safe.
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118
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Schmid M, Dodt C. Primärer Spontanpneumothorax – weniger ist manchmal mehr! Notf Rett Med 2021. [DOI: 10.1007/s10049-020-00743-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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119
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Saccomanno J, Hübner RH, Raspe M. [27/m-Sudden onset of chest pain, dyspnea and hemoptysis : Preparation for the medical specialist examination: part 3]. Internist (Berl) 2021; 62:18-23. [PMID: 33635369 DOI: 10.1007/s00108-021-00961-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2021] [Indexed: 11/29/2022]
Affiliation(s)
- J Saccomanno
- Medizinische Klinik m. S. Infektiologie und Pneumologie, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Deutschland.
| | - R-H Hübner
- Medizinische Klinik m. S. Infektiologie und Pneumologie, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Deutschland
| | - M Raspe
- Medizinische Klinik m. S. Infektiologie und Pneumologie, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Deutschland
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120
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Giles AE, Kidane B, Schellenberg M, Ball CG. The Primary Spontaneous Pneumothorax trial: A critical appraisal from the surgeon's perspective. J Thorac Cardiovasc Surg 2021; 162:1428-1432. [PMID: 33773816 DOI: 10.1016/j.jtcvs.2021.02.070] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Revised: 02/07/2021] [Accepted: 02/12/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Andrew E Giles
- Section of Thoracic Surgery, Department of Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Biniam Kidane
- Section of Thoracic Surgery, Department of Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; Research Institute in Oncology & Hematology, Cancer Care Manitoba, Winnipeg, Manitoba, Canada.
| | - Morgan Schellenberg
- Division of Acute Care Surgery, LAC + USC Medical Center, Los Angeles, Calif
| | - Chad G Ball
- Department of Surgery, University of Calgary, Calgary, Alberta, Canada
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121
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Spontaneous Pneumothorax: New Horizons. JOURNAL OF RESPIRATION 2021. [DOI: 10.3390/jor1010008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Spontaneous pneumothorax can be divided into two categories: primary and secondary. The management of each one depends on resource availability, physician preference, and procedural capability, and is broadly based on guidelines that are over a decade old. Emerging evidence from three recent randomized controlled trials on ambulatory pneumothorax pathways are exciting and herald a new era for management of spontaneous pneumothorax. These three trials and their implications are discussed.
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Abstract
A pneumothorax is defined by the presence of free air between the pleura visceralis and the pleura partietalis. The lung separates from the chest wall, which then, depending on several parameters, leads to a slight or clinically threatening impairment of lung function. Non-specific signs such as thoracic pain or coughing are common and do not correlate with the extent of the pneumothorax. Almost without exception, the cause of this accumulation of air is a leakage in the lung's surface, which then results in air escaping into the pleural space. Depending on the cause of the "lung leakage", a distinction is made between a primary (idiopathic) spontaneous pneumothorax (PSP) that can be triggered without direct cause, and a secondary spontaneous pneumothorax (SSP) in case of an underlying known lung disease. Further between an iatrogenic pneumothorax in connection with a lung injury caused by medical measures, and a traumatic pneumothorax in the case of an accident-related lung tear. The relevant therapeutic goals are the elimination of the acute symptoms, the reliable achievement of re-expansion of the lungs, and, after appropriate information gathering about the probability and clinical significance of a pneumothorax recurrence and depending on the patient's wish, avoiding a recurrence by means of surgical measures. The therapy options range from a "wait-and-see" procedure, that merely monitors the findings, to a primary video-assisted thoracoscopic surgical therapy with detection and resection of the superficial lung lesion, as well as a measurement to obliterate the pleural cavity that prevents relapse. Regarding "follow-up care" or even behavioral recommendations after a pneumothorax, there are no recommendations that reduce the risk of recurrence.
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123
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Fatovich DM. Research, kindness and the antifragility of emergency medicine. Emerg Med Australas 2021; 33:385-387. [PMID: 33517577 DOI: 10.1111/1742-6723.13730] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 01/12/2021] [Indexed: 01/07/2023]
Abstract
Antifragility is a property of things that benefit from shocks, randomness and uncertainty and love adventure and risk. This describes emergency medicine. Improving evidence-based medicine requires a learning health system, where the whole system is constructed to advance patient care via research driven excellence. So we need to develop our own evidence base by embedding research into everyday practice. Clinical research is messy but the repeated stress testing of clinical practice via research enhances our antifragility. This is even more important because our world is complex, as are humans. Unfortunately, the human brain is hard wired for simplicity, making us disinclined to challenge the status quo. Yet probably <10% of our practice is supported by high-level evidence. Research is altruistic and a form of kindness for our patients, which includes having a culture of research within a learning health system, so that we can be thoughtful!
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Affiliation(s)
- Daniel M Fatovich
- Department of Emergency Medicine, Royal Perth Hospital, The University of Western Australia, Perth, Western Australia, Australia.,Centre for Clinical Research in Emergency Medicine, Harry Perkins Institute of Medical Research, Perth, Western Australia, Australia
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124
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Ennis SL, Dobler CC. Conservative versus interventional treatment for spontaneous pneumothorax. Breathe (Sheff) 2021; 16:200171. [PMID: 33447279 PMCID: PMC7792830 DOI: 10.1183/20734735.0171-2020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
For a primary spontaneous pneumothorax (PSP) (in a person with no underlying lung disease) with a visible rim of >2 cm between the lung margin and the chest wall (at the level of the hilum) on a chest radiograph, current guidelines recommend aspiration with a 16–18-gauge cannula and insertion of a small-bore chest drain (8–14 French) if the pneumothorax size cannot successfully be reduced below the 2 cm rim or the patient remains breathless [1]. As interventional management of PSP is associated with potential complications and a patient with a chest drain needs to be admitted to hospital, evaluation of conservative management as a potential alternative to interventional management of larger PSPs is desirable. Before the current trial, there were a few observational studies suggesting that moderate to large sized PSPs can potentially be successfully managed without intervention but evidence from randomised trials was lacking [2]. The PSP trial aimed to determine whether conservative management is an acceptable alternative to interventional management for uncomplicated, moderate-to-large PSP [3]. Conservative management (with a treatment escalation plan in case the patient deteriorates) is a safe alternative to interventional management of a primary spontaneous pneumothoraxhttps://bit.ly/3fIN4uh
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Affiliation(s)
- Samantha L Ennis
- Dept of Respiratory and Sleep Medicine, Liverpool Hospital, Sydney, NSW, Australia
| | - Claudia C Dobler
- Dept of Respiratory and Sleep Medicine, Liverpool Hospital, Sydney, NSW, Australia.,Institute for Evidence-Based Healthcare, Bond University, Robina, QLD, Australia
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125
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Improving care through standardized treatment of spontaneous pneumothorax. J Pediatr Surg 2021; 56:55-60. [PMID: 33139032 DOI: 10.1016/j.jpedsurg.2020.09.048] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Accepted: 09/22/2020] [Indexed: 11/23/2022]
Abstract
PURPOSE The objective of this quality improvement (QI) initiative was to implement a standardized clinical treatment protocol for patients presenting with primary spontaneous pneumothorax (PSP) in order to decrease hospital length of stay (LOS), diagnostic radiation exposure, and related cost. METHODS Baseline data from patients admitted with PSP from January 1, 2016 to July 31, 2018 were compared to data from patients managed using a newly developed evidence-based treatment pathway from August 1, 2018 to December 31, 2019. Standard QI methodology was used to track results. RESULTS Fifty-six episodes of PSP were observed during the baseline period and 40 episodes of PSP following initiation of the PSP protocol. The average LOS decreased from 4.5 days to 2.9 days. Patients underwent an average of 8.8 X-rays per admission preintervention versus 5.9 postintervention. The rate of CT scans decreased from 45% to 15% (p = 0.002). There was no significant difference in the rates of 30-day recurrence between the preintervention (13%) and postintervention (10%) groups (p = 0.7). Average admission costs per patient decreased by $1322 after adoption of the pathway. CONCLUSIONS Adoption of a standardized treatment protocol for PSP led to a reduction in LOS, diagnostic imaging utilization, and cost without increasing clinical recurrence. TYPE OF STUDY Quality improvement. LEVEL OF EVIDENCE Level III.
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126
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Jouneau S, Vuillard C, Salé A, Bazin Y, Sohier L, Kerjouan M, Ricard JD, Messika J. Outpatient management of primary spontaneous pneumothorax. Respir Med 2020; 176:106240. [PMID: 33248364 DOI: 10.1016/j.rmed.2020.106240] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 11/10/2020] [Accepted: 11/16/2020] [Indexed: 01/01/2023]
Abstract
The outpatient management of primary spontaneous pneumothorax (PSP) is still debated. The risk of a tension pneumothorax is used to justify active treatment like chest-tube drainage, although outpatient management can reduce both the time in hospital and the cost of treatment. It is also likely to be the patient's choice. This report is a reappraisal of the situations for which outpatient management, by monitoring alone, or using minimally invasive techniques, can be considered.
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Affiliation(s)
- Stéphane Jouneau
- Service de Pneumologie, Centre de Compétences pour Les Maladies Pulmonaires Rares, Hôpital Pontchaillou, Rennes, France; IRSET UMR, 1085, Université de Rennes 1, Rennes, France
| | - Constance Vuillard
- Service de Réanimation Médico-Chirurgicale, AP-HP.Nord - Université de Paris, Hôpital Louis Mourier, F-92700, Colombes, France
| | - Alexandre Salé
- Service de Pneumologie, Centre de Compétences pour Les Maladies Pulmonaires Rares, Hôpital Pontchaillou, Rennes, France
| | - Yann Bazin
- Service des Maladies Respiratoires et Infectieuses, Hôpital Broussais, 35400, Saint-Malo, France
| | - Laurent Sohier
- Service de Pneumologie, Centre Hospitalier Bretagne Sud, Lorient, France
| | - Mallorie Kerjouan
- Service de Pneumologie, Centre de Compétences pour Les Maladies Pulmonaires Rares, Hôpital Pontchaillou, Rennes, France
| | - Jean-Damien Ricard
- Service de Réanimation Médico-Chirurgicale, AP-HP.Nord - Université de Paris, Hôpital Louis Mourier, F-92700, Colombes, France; Université de Paris, Infection, Antimicrobials, Modelling, Evolution, IAME, UMR 1137, INSERM, F, 75018, Paris, France
| | - Jonathan Messika
- Service de Pneumologie B et Transplantation Pulmonaire, AP-HP.Nord - Université de Paris, Hôpital Bichat-Claude Bernard, F-75018, Paris, France; Université de Paris, Physiopathology and Epidemiology of Respiratory Diseases, PHERE, UMR1152, INSERM, F-75018 Paris, France.
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127
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Lewit RA, Tutor A, Albrecht A, Weatherall YZ, Williams RF. Pediatric Spontaneous Pneumothorax: Does Initial Treatment Affect Outcomes? J Surg Res 2020; 259:532-537. [PMID: 33189361 DOI: 10.1016/j.jss.2020.10.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 09/30/2020] [Accepted: 10/13/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Primary spontaneous pneumothorax (PSP) commonly occurs in adolescents, most commonly in males, and has recurrence rates between 20% and 60%. Surgical therapy has long been debated regarding its role in preventing recurrence, with no current consensus on guidelines for care. The purpose of this study is to examine the effect of treatment type on recurrence rates in pediatric PSP. METHODS This is a single-institution, institutional review board-approved retrospective analysis of patients aged 1 to 18 diagnosed with their first occurrence of PSP between 2009 and 2017. Patient demographics, hospital course, and outcomes over a 2-y period were collected. Patients were divided into nonoperative (oxygen therapy only) management, chest tube placement, and surgical management. The primary outcome was the recurrence rate. RESULTS Sixty-four patients diagnosed with PSP met inclusive criteria. The mean age was 15.5, and 48 (75%) of patients were men. Twenty-one patients (33%) underwent nonoperative treatment, 24 patients (37.5%) underwent operative treatment with video-assisted thoracoscopic surgery or open thoracotomy, and 19 patients (30%) underwent chest tube or pigtail placement alone. Fifteen patients (23.4%) experienced a recurrence within 2 y: 6 patients (29%) from the nonoperative treatment group, 4 (21%) who were treated with the chest tube only, and 5 (21%) who underwent video-assisted thoracoscopic surgery or open thoracotomy. No statistically significant difference in recurrence rates was found between treatment groups. Pneumothorax size was found to differ between treatment type; larger pneumothoraces were more likely to undergo surgical intervention (P = 0.0003). Smaller pneumothoraces were associated with higher rates of recurrence on multivariate logistic regression analysis (P = 0.046). CONCLUSIONS Recurrence of PSP in adolescents was found to be 23.4% after 2-y follow-up. Smaller-sized pneumothoraces were associated with higher rates of recurrence, but treatment type did not significantly affect recurrence rates.
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Affiliation(s)
- Ruth A Lewit
- The University of Tennessee Health Science Center, Le Bonheur Children's Hospital, Memphis, Tennessee.
| | - Austin Tutor
- University of Tennessee Health Science Center, Memphis, Tennessee
| | - Adam Albrecht
- University of Tennessee Health Science Center, Memphis, Tennessee
| | - Ying Z Weatherall
- The University of Tennessee Health Science Center, Le Bonheur Children's Hospital, Memphis, Tennessee
| | - Regan F Williams
- The University of Tennessee Health Science Center, Le Bonheur Children's Hospital, Memphis, Tennessee
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128
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Jouneau S, Sohier L, Bazin Y, Salé A, Messika J. Conservative management of primary spontaneous pneumothorax: A failed revolution? Respir Med Res 2020; 79:100796. [PMID: 33242735 DOI: 10.1016/j.resmer.2020.100796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 10/29/2020] [Indexed: 11/25/2022]
Affiliation(s)
- S Jouneau
- Department of respiratory medicine, competence centre for rare pulmonary diseases, CHU Rennes, Rennes, France; UMR_S 1085, Inserm, EHESP, institut de recherche en santé, environnement et travail (IRSET), CHU Rennes, university Rennes, 35000 Rennes, France.
| | - L Sohier
- Department of respiratory medicine, centre hospitalier Bretagne Sud, Lorient, France
| | - Y Bazin
- Department of respiratory medicine, centre hospitalier de Saint-Malo, Saint-Malo, France
| | - A Salé
- Department of respiratory medicine, competence centre for rare pulmonary diseases, CHU Rennes, Rennes, France
| | - J Messika
- Inserm UMR 1152, université de Paris, hôpital Bichat Claude-Bernard, AP-HP nord, Paris, France
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129
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Chen Z, Zhao W, Wang L, Jin K, Shen J. Comments on therapy option for primary spontaneous pneumothorax. J Thorac Dis 2020; 12:6416-6418. [PMID: 33282342 PMCID: PMC7711393 DOI: 10.21037/jtd-20-1759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Zixuan Chen
- Department of Cardiothoracic Surgery, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, China.,Department of Thoracic Surgery, The Affiliated Hospital of Medical School, Ningbo University, Ningbo, China
| | - Weijun Zhao
- Department of Thoracic Surgery, Ningbo First Hospital, Ningbo, China
| | - Linyao Wang
- Department of Cardiothoracic Surgery, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, China
| | - Ke Jin
- Department of Cardiothoracic Surgery, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, China
| | - Jianfei Shen
- Department of Cardiothoracic Surgery, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, China
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Chest Tube Drainage Versus Conservative Management as the Initial Treatment of Primary Spontaneous Pneumothorax: A Systematic Review and Meta-Analysis. J Clin Med 2020; 9:jcm9113456. [PMID: 33121119 PMCID: PMC7693596 DOI: 10.3390/jcm9113456] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 10/19/2020] [Accepted: 10/26/2020] [Indexed: 02/07/2023] Open
Abstract
Objectives: This systematic review and meta-analysis aimed to compare chest tube drainage and conservative management as the initial treatment of primary spontaneous pneumothorax (PSP). Methods: Studies including PSP patients who received tube drainage or conservative management as the initial treatment were searched in OVID-MEDLINE and Embase through 14 February 2020. The primary outcome was the relative risk (RR) of PSP recurrence, and secondary outcomes were RRs of PSP resolution and adverse events during treatment. A random-effect model using the Mantel–Haenszel method was used to pool RRs. Subgroup and meta-regression analyses were performed to investigate significant predictors of PSP recurrence. Results: In total, 11,922 PSP cases from eight studies were analysed, of which 6344 were treated with tube drainage and 5578 were treated with conservative management. The pooled RR of PSP recurrence for conservative management against tube drainage was 0.98 (95% confidence interval [CI], 0.75–1.28; p = 0.894). Subgroup and meta-regression analyses revealed that study design (p = 0.816), allocation of the PSP amount in each management group (p = 0.191), and assessment time for recurrence had no significant impact on PSP recurrence (p = 0.816). There was no publication bias (p = 0.475). The risk of adverse events of conservative management was significantly lower than that of tube drainage (pooled RR, 0.22; 95% CI, 0.08–1.15; p = 0.003). However, no difference was found between the two groups in terms of PSP resolution (pooled RR, 1.01; 95% CI, 0.9–1.15; p = 0.814). Conclusions: As the initial treatment for PSP, conservative management is comparable to chest tube drainage in terms of PSP recurrence and resolution after treatment, with fewer adverse events during treatment.
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131
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Liu WL, Lv K, Deng HS, Hong QC. Comparison of efficiency and safety of conservative versus interventional management for primary spontaneous pneumothorax: A meta-analysis. Am J Emerg Med 2020; 45:352-357. [PMID: 33046307 DOI: 10.1016/j.ajem.2020.08.092] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 08/18/2020] [Accepted: 08/27/2020] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND There is growing opinion that primary spontaneous pneumothorax (PSP) patients without hemodynamic compromise could be safely and successfully managed with observation alone. The aims of this meta-analysis were to estimate the safety and effectiveness of conservative treatment compared with that of interventional management as the initial treatment option for patients with PSP. METHODS The PubMed, Embase and Cochrane library databases were systematically searched for randomized controlled trials (RCTs) and cohort studies (prospective or retrospective) until April 25, 2020, that compared conservative treatment and interventional treatment as the initial treatment for patients with PSP. The primary outcomes were success rates and recurrence rates. The secondary outcome was complication rates. Data extraction and quality assessment from eligible studies were independently conducted by two reviewers. RESULTS 8 trials with a total of 1342 patients were identified. The success rates of conservative management were similar with interventional treatment, with a risk ratio 1.05 (95% confidence interval 0.94 to 1.17, I2 = 69.1%). There was no significant difference of recurrence rates between these two type managements. (RR, 1.43, 95% confidence interval 0.45 to 4.55, I2 = 86.7%). Complication rates were lower in conservative treatment group (13 of 215 [6.05%]) than in interventional treatment group (57 of 212, [26.89%]), although the difference did not reach statistical significance (RR, 0.15, 95% CI, 0.02 to 1.13, I2 = 56.7%). CONCLUSIONS Results of the meta-analysis suggest that conservative treatment offers a safe and effective alternative as compared with interventional management as the initial treatment approach for patients with PSP. However, more randomized clinical trials are need to provide more strong evidence to confirm our results.
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Affiliation(s)
- Wan-Li Liu
- The Department of Cardiothoracic Surgery, Longgang Central Hospital of Shenzhen, Address: No. 6028 Longgang Avenue, Longgang District, Shenzhen, PR China; Zunyi Medical University, No.6 Xuefu West Road, Xinpu New District, Zunyi City, China
| | - Kun Lv
- The Department of Cardiothoracic Surgery, Longgang Central Hospital of Shenzhen, Address: No. 6028 Longgang Avenue, Longgang District, Shenzhen, PR China
| | - Hong-Shen Deng
- The Department of Cardiothoracic Surgery, Longgang Central Hospital of Shenzhen, Address: No. 6028 Longgang Avenue, Longgang District, Shenzhen, PR China; Zunyi Medical University, No.6 Xuefu West Road, Xinpu New District, Zunyi City, China
| | - Qiong-Chuan Hong
- The Department of Cardiothoracic Surgery, Longgang Central Hospital of Shenzhen, Address: No. 6028 Longgang Avenue, Longgang District, Shenzhen, PR China; Zunyi Medical University, No.6 Xuefu West Road, Xinpu New District, Zunyi City, China.
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132
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Interventionelles versus konservatives Management des Spontanpneumothorax. Pneumologie 2020. [DOI: 10.1055/a-1212-9458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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133
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Gotthardt P, Baumgärtel M, Geise A, Ficker JH. [Respiratory emergency after chest drain for spontaneous pneumothorax-re-expansion pulmonary oedema meets anaphylaxis]. Med Klin Intensivmed Notfmed 2020; 116:354-356. [PMID: 32778910 DOI: 10.1007/s00063-020-00692-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 03/25/2020] [Accepted: 04/02/2020] [Indexed: 11/24/2022]
Affiliation(s)
- P Gotthardt
- Klinik für Innere Medizin 3, Schwerpunkt Pneumologie, Klinikum Nürnberg, Universitätsklinik der Paracelsus Medizinischen Privatuniversität, Prof.-Ernst-Nathan-Str. 1, 90419, Nürnberg, Deutschland.
| | - M Baumgärtel
- Klinik für Innere Medizin 3, Schwerpunkt Pneumologie, Klinikum Nürnberg, Universitätsklinik der Paracelsus Medizinischen Privatuniversität, Prof.-Ernst-Nathan-Str. 1, 90419, Nürnberg, Deutschland
| | - A Geise
- Klinik für Innere Medizin 3, Schwerpunkt Pneumologie, Klinikum Nürnberg, Universitätsklinik der Paracelsus Medizinischen Privatuniversität, Prof.-Ernst-Nathan-Str. 1, 90419, Nürnberg, Deutschland
| | - J H Ficker
- Klinik für Innere Medizin 3, Schwerpunkt Pneumologie, Klinikum Nürnberg, Universitätsklinik der Paracelsus Medizinischen Privatuniversität, Prof.-Ernst-Nathan-Str. 1, 90419, Nürnberg, Deutschland
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134
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Kapp C, Feller-Kopman D. Ambulatory management of primary spontaneous pneumothorax: when less is more. Lancet 2020; 396:4-5. [PMID: 32622395 DOI: 10.1016/s0140-6736(20)31306-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 06/01/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Christopher Kapp
- Division of Pulmonary and Critical Care Medicine, The Johns Hopkins Hospital, Baltimore, MD 21287, USA
| | - David Feller-Kopman
- Division of Pulmonary and Critical Care Medicine, The Johns Hopkins Hospital, Baltimore, MD 21287, USA.
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135
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Hallifax RJ, McKeown E, Sivakumar P, Fairbairn I, Peter C, Leitch A, Knight M, Stanton A, Ijaz A, Marciniak S, Cameron J, Bhatta A, Blyth KG, Reddy R, Harris MC, Maddekar N, Walker S, West A, Laskawiec-Szkonter M, Corcoran JP, Gerry S, Roberts C, Harvey JE, Maskell N, Miller RF, Rahman NM. Ambulatory management of primary spontaneous pneumothorax: an open-label, randomised controlled trial. Lancet 2020; 396:39-49. [PMID: 32622394 PMCID: PMC7607300 DOI: 10.1016/s0140-6736(20)31043-6] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 04/18/2020] [Accepted: 04/23/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND Primary spontaneous pneumothorax occurs in otherwise healthy young patients. Optimal management is not defined and often results in prolonged hospitalisation. Data on efficacy of ambulatory options are poor. We aimed to describe the duration of hospitalisation and safety of ambulatory management compared with standard care. METHODS In this open-label, randomised controlled trial, adults (aged 16-55 years) with symptomatic primary spontaneous pneumothorax were recruited from 24 UK hospitals during a period of 3 years. Patients were randomly assigned (1:1) to treatment with either an ambulatory device or standard guideline-based management (aspiration, standard chest tube insertion, or both). The primary outcome was total length of hospital stay including re-admission up to 30 days after randomisation. Patients with available data were included in the primary analysis and all assigned patients were included in the safety analysis. The trial was prospectively registered with the International Standard Randomised Clinical Trials Number, ISRCTN79151659. FINDINGS Of 776 patients screened between July, 2015, and March, 2019, 236 (30%) were randomly assigned to ambulatory care (n=117) and standard care (n=119). At day 30, the median hospitalisation was significantly shorter in the 114 patients with available data who received ambulatory treatment (0 days [IQR 0-3]) than in the 113 with available data who received standard care (4 days [IQR 0-8]; p<0·0001; median difference 2 days [95% CI 1-3]). 110 (47%) of 236 patients had adverse events, including 64 (55%) of 117 patients in the ambulatory care arm and 46 (39%) of 119 in the standard care arm. All 14 serious adverse events occurred in patients who received ambulatory care, eight (57%) of which were related to the intervention, including an enlarging pneumothorax, asymptomatic pulmonary oedema, and the device malfunctioning, leaking, or dislodging. INTERPRETATION Ambulatory management of primary spontaneous pneumothorax significantly reduced the duration of hospitalisation including re-admissions in the first 30 days, but at the expense of increased adverse events. This data suggests that primary spontaneous pneumothorax can be managed for outpatients, using ambulatory devices in those who require intervention. FUNDING UK National Institute for Health Research.
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Affiliation(s)
- Rob J Hallifax
- Oxford Centre for Respiratory Medicine, University of Oxford, Oxford, UK.
| | - Edward McKeown
- Royal Berkshire National Health Service (NHS) Foundation Trust, Reading, UK
| | | | | | - Christy Peter
- Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - Andrew Leitch
- Western General Hospital, NHS Lothian, Edinburgh, UK
| | | | - Andrew Stanton
- Great Western Hospital NHS Foundation Trust, Swindon, UK
| | - Asim Ijaz
- University Hospitals of Morecambe Bay NHS Foundation Trust, Lancaster, UK
| | | | | | - Amrithraj Bhatta
- Blackpool Fylde and Wyre Hospitals NHS Foundation Trust, Blackpool, UK
| | - Kevin G Blyth
- Queen Elizabeth University Hospital, Glasgow, UK; Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Raja Reddy
- Kettering General Hospital, Kettering, UK
| | | | | | - Steven Walker
- Academic Respiratory Unit, University of Bristol, Bristol, UK
| | - Alex West
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | | | | | - Stephen Gerry
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Corran Roberts
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | | | - Nick Maskell
- Academic Respiratory Unit, University of Bristol, Bristol, UK
| | - Robert F Miller
- Institute for Global Health, University College London, London, UK
| | - Najib M Rahman
- Oxford Respiratory Trials Unit, University of Oxford, Oxford, UK
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136
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Feller‐Kopman D. Interventional pulmonology: There is no going back, only forward. Respirology 2020; 25:909-910. [DOI: 10.1111/resp.13896] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 06/11/2020] [Indexed: 12/14/2022]
Affiliation(s)
- David Feller‐Kopman
- Director, Bronchoscopy and Interventional Pulmonology, Professor of Medicine, Anesthesiology, Otolaryngology – Head and Neck SurgeryJohns Hopkins Hospital Baltimore MD USA
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137
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Thomas R, Rahman NM, Maskell NA, Lee YCG. Pleural effusions and pneumothorax: Beyond simple plumbing: Expert opinions on knowledge gaps and essential next steps. Respirology 2020; 25:963-971. [PMID: 32613624 DOI: 10.1111/resp.13881] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 04/15/2020] [Accepted: 04/29/2020] [Indexed: 12/17/2022]
Abstract
Pleural diseases affect millions of people worldwide. Pleural infection, malignant pleural diseases and pneumothorax are common clinical challenges. A large number of recent clinical trials have provided an evidence-based platform to evaluate conventional and novel methods to drain pleural effusions/air which reduce morbidity and unnecessary interventions. These successes have generated significant enthusiasm and raised the profile of pleural medicine as a new subspecialty. The ultimate goal of pleural research is to prevent/stop development of pleural effusions/pneumothorax. Current research studies mainly focus on the technical aspects of pleural drainage. Significant knowledge gaps exist in many aspects such as understanding of the pathobiology of the underlying pleural diseases, pharmacokinetics of pleural drug delivery, etc. Answers to these important questions are needed to move the field forward. This article collates opinions of leading experts in the field in highlighting major knowledge gaps in common pleural diseases to provoke thinking beyond pleural drainage. Recognizing the key barriers will help prioritize future research in the quest to ultimately cure (rather than just drain) these pleural conditions.
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Affiliation(s)
- Rajesh Thomas
- Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, WA, Australia.,Pleural Medicine Unit, Institute for Respiratory Health, Perth, WA, Australia
| | - Najib M Rahman
- Oxford Centre for Respiratory Medicine, Churchill Hospital, Oxford, UK.,Oxford NIHR Biomedical Research Centre, Oxford, UK
| | - Nick A Maskell
- Academic Respiratory Unit, Bristol Medical School, University of Bristol, Bristol, UK.,North Bristol Lung Centre, North Bristol NHS Trust, Bristol, UK
| | - Y C Gary Lee
- Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, WA, Australia.,Pleural Medicine Unit, Institute for Respiratory Health, Perth, WA, Australia.,Centre for Respiratory Health, School of Medicine, University of Western Australia, Perth, WA, Australia
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138
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Recurrence of primary spontaneous pneumothorax: Associated factors. Pulmonology 2020; 28:276-283. [PMID: 32601016 DOI: 10.1016/j.pulmoe.2020.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 05/30/2020] [Accepted: 06/02/2020] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Determining the risk of recurrence of primary spontaneous pneumothorax is challenging. The objective of this study was to develop a risk assessment model to predict the probability of recurrence in patients with spontaneous pneumothorax. METHODS A retrospective study was performed of all episodes of pneumothorax diagnosed in the last 12 years in a hospital, in patients not initially submitted to surgery. Logistic regression was used to estimate the probability of recurrence. Based on a set of variables, a predictive model was built with its corresponding ROC curve to determine its discrimination power and diagnostic precision. RESULTS Of the 253 patients included, 128 (50.6%) experienced recurrence (37% within the first year). Recurrence was detected within 110 days in 25% of patients. The median of time to recurrence for the whole population was 1120 days. The presence of blebs/bullae was found to be a risk factor of recurrence (OR: 5.34; 95% CI: 2.81-10.23; p=0.000), whereas chest drainage exerted protective effect (OR: 0.19; 95% CI: 0.08-0.40; p=0.000). The variables included in the regression model constructed were hemoglobin and leukocyte count in blood, treatment received, and presence of blebs/bullae, with a fair discriminative power to predict recurrence [AUC=0.778 (95% CI: 0.721-0.835)]. CONCLUSION The overall recurrence rate was high and was associated with the presence of blebs/bullae, failure to perform an active intervention (chest drainage) and low levels of hemoglobin and leukocytes in blood. Recurrence rarely occurs later than three years after the first episode. Once validated, this precision model could be useful to guide therapeutic decisions.
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139
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Welch H, Walker S, Maskell N. Current Management Strategies for Primary Spontaneous Pneumothorax. CURRENT PULMONOLOGY REPORTS 2020. [DOI: 10.1007/s13665-020-00249-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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140
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Exclusive ambulatory management of spontaneous pneumothorax with pigtail catheters, a prospective multicentric study. Respir Med 2020; 166:105931. [DOI: 10.1016/j.rmed.2020.105931] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Revised: 03/01/2020] [Accepted: 03/09/2020] [Indexed: 12/16/2022]
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141
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Abstract
Pleural manometry (PM) is a novel tool that allows direct measurement of the pressure in the pleural space in the presence of either a pleural effusion or a pneumothorax. Originally it was used to guide therapy for tuberculosis (TB) before the development of anti-TB medications. It was relegated to highly specialized centers for thoracoscopies until Light used it to investigate pleural effusions in the 1980s. However, there remains lack of robust data to support the routine use of PM. Recently additional published studies have generated renewed interest supporting the use of PM in specialized cases of complex pleural disorders. In this paper we summarize the current different techniques, applications, and pitfalls for the use of PM.
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Affiliation(s)
- Kurt Hu
- Division of Pulmonary and Critical Care Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Amit Chopra
- Division of Pulmonary and Critical Care Medicine, Albany Medical College, Albany, NY, USA
| | - John Terrill Huggins
- Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Rahul Nanchal
- Division of Pulmonary and Critical Care Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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142
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Affiliation(s)
- Enid R Neptune
- Johns Hopkins University School of Medicine, Baltimore, MD
| | - Hal Dietz
- Johns Hopkins University School of Medicine, Baltimore, MD
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143
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Nguyen P, Lee P, Kurimoto N. The changing field of interventional pulmonology. Respirology 2020; 25:911-913. [PMID: 32337814 DOI: 10.1111/resp.13821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 03/29/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Phan Nguyen
- Department of Thoracic Medicine, The Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Pyng Lee
- Division of Respiratory and Critical Care Medicine, The National University Hospital, Singapore
| | - Noriaki Kurimoto
- Department of Internal Medicine, Division of Medical Oncology and Respiratory Medicine, Shimane University Faculty of Medicine, Izumo, Japan
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144
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Walker K, Tan SI, Fatovich D, Watkins G, Stephenson M, Ting J, Whittome R, Wang W, Knott J. Research capacity of Australian and New Zealand emergency medicine departments. Int J Emerg Med 2020; 13:16. [PMID: 32293255 PMCID: PMC7161130 DOI: 10.1186/s12245-020-00275-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 03/31/2020] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Large, multicentre studies are required in emergency medicine to advance clinical care and improve patient outcomes. The Australasian College for Emergency Medicine clinical trials network is available to researchers to assist with facilitating large, multicentre research. However, there is no current information about the research capacity of emergency departments (EDs) in Australia and New Zealand. METHODS All EDs accredited for emergency medicine training in Australia and New Zealand were eligible to participate. Research leads or ED directors were invited via email and telephone to complete a survey. Data were collected regarding the presence of a research lead; their research experience; available research resources including colleagues, funding, departmental paid research time; publications; and research culture. RESULTS One hundred and twelve responses were received on behalf of 122 (84%) sites (10 satellite plus main) from a possible 143 sites with all types of hospitals and regions represented. Research leads were identified at 66 (59%) sites; 32 (29%) had a director of emergency medicine research. A wide range of research was underway. Ninety-six sites (66%) contributed data to multicentre projects. Twenty-one centres (17%) were highly productive with multiple resources (skilled colleagues, funding, staffing), a positive research culture and high-volume output. Sixty to seventy centres (50-58%) had limited resources, experienced an unsupportive research culture and authored manuscripts infrequently. Paid time for research directors was associated with increased research outputs. DISCUSSION ACEM sites have the capacity to undertake large multicentre studies with a varied network of sites and researchers. While some sites are well equipped for research, the majority of EDs had minimal research output.
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Affiliation(s)
- Katie Walker
- Emergency Department, Cabrini, 183 Wattletree Rd, Malvern, Melbourne, Victoria, 3144, Australia. .,Health Services, Monash University, Melbourne, Victoria, 3004, Australia.
| | - Shijie Ian Tan
- Emergency Department, Cabrini, 183 Wattletree Rd, Malvern, Melbourne, Victoria, 3144, Australia.,Faculty of Medicine, Nursing and Health Sciences, Monash University, Building 15, 27 Rainforest Walk, Clayton Campus, Wellington Rd, Clayton, Victoria, 3800, Australia.,Ng Teng Fong General Hospital, 1 Jurong East Street 21, Singapore, 609606, Singapore
| | - Daniel Fatovich
- Department of Emergency Medicine, Royal Perth Hospital, GPO Box X2213, Perth, 6001, Western Australia.,Centre for Clinical Research in Emergency Medicine, Harry Perkins Institute of Medical Research, University of Western Australia, Perth, 6001, Australia
| | - Gina Watkins
- Emergency Department, Sutherland Hospital, Caringbah, Sydney, NSW, 2229, Australia.,School of Medicine, University of New South Wales, Sydney, New South Wales, 2052, Australia
| | - Melanie Stephenson
- Emergency Department, Cabrini, 183 Wattletree Rd, Malvern, Melbourne, Victoria, 3144, Australia.,Health Services, Monash University, Melbourne, Victoria, 3004, Australia.,Emergency Department, Austin Hospital, Heidelberg, Victoria, 3084, Australia
| | - Joseph Ting
- Mater Hospital, Raymond Terrace, South Brisbane, Queensland, 4101, Australia.,Ipswich Hospital, Chelmsford Ave, Ipswich, Queensland, 4305, Australia.,School of Public Health and Social Work, Queensland University of Technology, 2 George St, Brisbane City, Queensland, 4000, Australia
| | - Richard Whittome
- Australasian College for Emergency Medicine, West Melbourne, Victoria, 3003, Australia
| | - Wei Wang
- Cabrini Institute, 154 Wattletree Rd, Malvern, Victoria, 3144, Australia.,Faculty of Medicine, Nursing and Health Sciences, Monash University, 553 St Kilda Rd, Melbourne, Victoria, 3004, Australia
| | - Jonathan Knott
- Emergency Department, Royal Melbourne Hospital, 300 Grattan St, Parkville, Victoria, 3050, Australia.,Melbourne Medical School, University of Melbourne, Grattan Street, Melbourne, Victoria, 3010, Australia
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145
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Steurer J. [Not Available]. PRAXIS 2020; 109:473-474. [PMID: 32345179 DOI: 10.1024/1661-8157/a003456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
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146
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Affiliation(s)
- V Courtney Broaddus
- From the Department of Medicine, University of California San Francisco, San Francisco
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