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Baudat-Nguyen J, Schneider J, Roth-Kleiner M, Barrielle L, Diebold P, Duvoisin G, El Faleh I, Grupe S, Huber BM, Morel AS, Paccaud Y, Torregrossa A, Younes D, Tolsa JF, Truttmann AC. Incidence and Management of Neonatal Pneumothorax in a 10-Hospital Regional Perinatal Network in Switzerland: A Retrospective Observational Study. Am J Perinatol 2024; 41:e3305-e3312. [PMID: 38154466 PMCID: PMC11150061 DOI: 10.1055/s-0043-1777861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 10/17/2023] [Indexed: 12/30/2023]
Abstract
OBJECTIVE Pneumothorax (PTX) is a potentially life-threatening condition that affects neonates, with an incidence of 0.05 to 2%. Its management includes conservative treatment, chest tube (CT) drainage, and needle aspiration (NA). Aims were to evaluate the incidence of PTX in a 10-hospital perinatal network, its clinical characteristics and risk factors, and to compare the different treatment options. STUDY DESIGN All neonates diagnosed with PTX and hospitalized in the network were included in this retrospective observational trial over a period of 30 months. Primary outcome was the incidence of PTX. Secondary outcomes were the treatment modality, the length of stay (LOS), and the number of chest X-rays. RESULTS Among the 173 neonates included, the overall incidence of PTX was 0.56 per 100 births with a large range among the hospitals (0.12-1.24). Thirty-nine percent of pneumothoraces were treated conservatively, 41% by CT drainage, 13% by NA, and 7% by combined treatment. Failure rate was higher for NA (37%) than for CT drainage (9%). However, the number of X-rays was lower for patients treated by NA, with a median of 6 (interquartile range [IQR] 4-6.25), than by CT drainage, with a median of 9 (IQR 7-12). LOS was shorter for NA than for CT drainage, with a median of 2 (IQR 1-4.25) and 6 days (IQR 3-15), respectively. Complications, including apnea and urinary retention, occurred in 28% of patients managed with CT drainage, whereas none was observed with NA. CONCLUSION High variability of PTX incidence was observed among the hospitals within the network, but these values correspond to the literature. NA showed to reduce the number of X-rays, the LOS, and complications compared with CT drainage, but it carries a high failure rate. This study helped provide a new decisional management algorithm to harmonize and improve PTX treatment within our network. KEY POINTS · Neonatal PTX is a frequent pathology with a high incidence requiring urgent management.. · We report a large variability of PTX incidence between different hospitals of the same network.. · Needle aspiration carries higher failure rate, shorter hospital stay duration without complications reported..
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Affiliation(s)
- Julie Baudat-Nguyen
- Department Women-Mother-Child, Clinic of Neonatology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Juliane Schneider
- Department Women-Mother-Child, Clinic of Neonatology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Matthias Roth-Kleiner
- Department Women-Mother-Child, Clinic of Neonatology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Laureline Barrielle
- Department Women-Mother-Child, Clinic of Neonatology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
- Department of Pediatrics, Fribourg Cantonal Hospital, Fribourg, Switzerland
| | - Patrick Diebold
- Department of Pediatrics, Riviera-Chablais Hospital, Rennaz, Switzerland
| | - Gilles Duvoisin
- Department of Pediatrics, Riviera-Chablais Hospital, Rennaz, Switzerland
| | - Ikbel El Faleh
- Department of Pediatrics, Neuchâtel Hospital, Neuchâtel, Switzerland
| | - Silke Grupe
- Department of Pediatrics, Yverdon Hospital, Yverdon, Switzerland
| | - Benedikt M. Huber
- Department of Pediatrics, Fribourg Cantonal Hospital, Fribourg, Switzerland
| | | | - Yan Paccaud
- Clinic of Pediatrics, Hospital Center of Valais Romand, Hospital of Valais, Sion, Switzerland
| | - Anais Torregrossa
- Department Women-Mother-Child, Clinic of Neonatology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
- Department of Pediatrics, Morges Hospital, Morges, Switzerland
| | - Dany Younes
- Department of Pediatrics, De la Broye Intercantonal Hospital, Payerne, Switzerland
| | - Jean-François Tolsa
- Department Women-Mother-Child, Clinic of Neonatology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Anita C. Truttmann
- Department Women-Mother-Child, Clinic of Neonatology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
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Alkaaki A, Gilbert S. Surgical Management of Pleural Diseases - Primer for Radiologists. Semin Roentgenol 2023; 58:463-470. [PMID: 37973275 DOI: 10.1053/j.ro.2023.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 07/07/2023] [Accepted: 07/19/2023] [Indexed: 11/19/2023]
Affiliation(s)
- Aroub Alkaaki
- Division of Thoracic Surgery, The Ottawa Hospital, Ottawa, Canada; Faculty of Medicine, University of Ottawa, Ottawa, Canada; Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Canada
| | - Sebastien Gilbert
- Division of Thoracic Surgery, The Ottawa Hospital, Ottawa, Canada; Faculty of Medicine, University of Ottawa, Ottawa, Canada; Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Canada.
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Matus I, Mertens A, Wilton S, Raja H, Roedder T. Safety and Efficacy of Manual Aspiration Via Small Bore Chest Tube in Facilitating the Outpatient Management of Transbronchial Biopsy-related Iatrogenic Pneumothorax. J Bronchology Interv Pulmonol 2021; 28:272-280. [PMID: 33758149 DOI: 10.1097/lbr.0000000000000754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 01/08/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Iatrogenic pneumothorax complicates transbronchial biopsies with a prevalence of 1% to 6%. Conventional treatment consists of inpatient management with chest tube drainage. While aspiration techniques have been investigated in the management of both primary spontaneous and transthoracic lung biopsy-induced pneumothorax, its role in the management of transbronchial biopsy-iatrogenic pneumothorax (TBBX-IP) is undefined. An appealing treatment alternative for TBBX-IP may exist in the placement of a small bore chest tube (SBCT) followed by a manual aspiration (MA) technique promoting earlier SBCT removal to facilitate outpatient management. To our knowledge, no study exists evaluating the efficacy of MA via a SBCT performed specifically for TBBX-IP. PATIENTS AND METHODS Prospective evaluation of the efficacy of a protocolized pathway incorporating MA through a SBCT for the outpatient management of TBBX-IP. Primary outcome was the clinicoradiographic resolution of TBBX-IP avoiding hospitalizations. RESULTS A total of 763 biopsies performed; 31 complicated by TBBX-IP, 18 qualified for intervention. Sixteen were outpatients, 2 inpatients. Thirteen (81.25%) of the 16 outpatients were successfully treated with MA via SBCT and did not require admission. Twelve (75%) of these 13 had SBCT removed, 1 patient was discharged with SBCT and removed in 24 hours. Of the 18 patients requiring intervention, 13 (72.2%) were successfully treated with MA via SBCT enabling removal of SBCT. No patient required reintervention. CONCLUSION MA via SBCT represents a safe and viable management approach of TBBX-IP promoting earlier SBCT removal and decreased hospitalizations. Our results challenge conventional management of TBBX-IP warranting further investigation.
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Affiliation(s)
- Ismael Matus
- Thoracic Surgery and Interventional Pulmonology Service, Helen F. Graham Cancer Center and Research Institute, Christiana Care Health System
| | - Avalon Mertens
- Division of Pulmonary and Critical Care Medicine, Rutgers New Jersey Medical School, NJ
| | - Shannon Wilton
- Department of Medicine, Christiana Care Health System, Newark, DE
| | - Haroon Raja
- Thoracic Surgery and Interventional Pulmonology Service, Helen F. Graham Cancer Center and Research Institute, Christiana Care Health System
| | - Timothy Roedder
- Division of Pulmonary and Critical Care Medicine, Rutgers New Jersey Medical School, NJ
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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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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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Zhu P, Xia H, Sun Z, Zhu D, Deng L, Zhang Y, Zhang H, Wang D. Manual aspiration versus chest tube drainage in primary spontaneous pneumothorax without underlying lung diseases: a meta-analysis of randomized controlled trials. Interact Cardiovasc Thorac Surg 2019; 28:936-944. [PMID: 30608581 DOI: 10.1093/icvts/ivy342] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Revised: 11/07/2018] [Accepted: 11/19/2018] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVES Although primary spontaneous pneumothorax (PSP) is an extremely frequent pathology, there is still no clear consensus on the treatment for these patients. We performed a strict meta-analysis on the effectiveness of manual aspiration (MA) compared to chest tube drainage (CTD) for the treatment of PSP. METHODS A literature search was performed on PubMed, EMBASE and the Cochrane Library to identify randomized controlled trials comparing MA with CTD for the treatment of PSP. Independent reviewers evaluated the methodological quality of the included randomized controlled trials. Statistical heterogeneity among studies was quantitatively evaluated using the I-squared index. RESULTS Five randomized controlled trials were included, and a total of 358 subjects were reported on. We found that MA was related to significantly shorter hospital stays [in days; mean difference -1.70, 95% confidence interval (CI) -2.36 to -1.04; P < 0.00001, fixed effect model] compared with CTD. However, no significant differences were found between the 2 treatments for immediate success rate (risk ratio 1.15, 95% CI 0.73-1.81; P = 0.54), 1-year recurrence rate, 1-week success rate, time of recurrence, chest surgery rate or complication rate. Subgroup analysis showed that MA can provide a significantly lower hospitalization rate than CTD with a tube size of >12 Fr or a water seal drainage system. CONCLUSIONS On the basis of the currently available literature, MA is advantageous in the treatment of PSP because of shorter hospital stays. The subgroup analysis also indicates that MA can provide a lower hospitalization rate than CTD with a tube size of >12 Fr or a water seal drainage system. However, there are no significant differences between the 2 interventions with respect to immediate success rate, 1-year recurrence rate, 1-week success rate, time of recurrence, chest surgery rate or complication rate.
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Affiliation(s)
- Pengzhi Zhu
- Department of Cardio-Thoracic Surgery, Tianjin Hospital, Hexi District, Tianjin, China
| | - Honggang Xia
- Department of Cardio-Thoracic Surgery, Tianjin Hospital, Hexi District, Tianjin, China
| | - Zhongyi Sun
- Department of Cardio-Thoracic Surgery, Tianjin Hospital, Hexi District, Tianjin, China
| | - Deqing Zhu
- Department of Cardio-Thoracic Surgery, Tianjin Hospital, Hexi District, Tianjin, China
| | - Limin Deng
- Department of Cardio-Thoracic Surgery, Tianjin Hospital, Hexi District, Tianjin, China
| | - Yongmin Zhang
- Department of Cardio-Thoracic Surgery, Tianjin Hospital, Hexi District, Tianjin, China
| | - Haiquan Zhang
- Department of Cardio-Thoracic Surgery, Tianjin Hospital, Hexi District, Tianjin, China
| | - Dongbin Wang
- Department of Cardio-Thoracic Surgery, Tianjin Hospital, Hexi District, Tianjin, China
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Gariépy M, Beaunoyer M, Miron MC, Gravel J. Management and recurrence of spontaneous pneumothorax in children. Paediatr Child Health 2019; 25:86-92. [PMID: 33390745 DOI: 10.1093/pch/pxz032] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 02/17/2019] [Indexed: 11/12/2022] Open
Abstract
Objective No guideline clearly prescribes an approach to management of spontaneous pneumothorax in children. The objectives of this study were to evaluate practice variation in the management of spontaneous pneumothorax in children and its probability of recurrence. Methods This study was a retrospective chart review followed by a phone follow-up that included all children who had visited a tertiary care paediatric hospital for a first episode of spontaneous pneumothorax between 2008 and 2017. The primary outcomes were the management of pneumothorax (observation, oxygen, needle aspiration, intercostal chest tube, surgery) and the probability of recurrence. All charts were evaluated by a rater using a standardized report form and 10% of the charts were evaluated in duplicate. All children/families were contacted by phone to assess recurrence. The primary analyses were the proportions of each treatment modalities and recurrence, respectively. Results During the study period, 76 children were deemed eligible for the study. Among them, 59 had a primary spontaneous pneumothorax while 17 were secondary. The most common first therapeutic approaches were chest tube insertion (31), oxygen alone (27), and observation (14). A total of 54 patients were available for follow-up among whom a recurrence was observed in 28 (37% of the total cohort or 52% of available children). Conclusion Chest tube insertion was the first line of treatment in about 40% of children with a first spontaneous pneumothorax. In this population, the recurrence probability is established between 37 and 52% and the majority occurs in the following months.
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Affiliation(s)
- Martin Gariépy
- Faculty of Medicine, Université Laval, Quebec City, Quebec
| | - Mona Beaunoyer
- Department of Surgery, CHU Sainte-Justine, Université de Montréal, Montréal, Quebec
| | - Marie-Claude Miron
- Department of Radiology, CHU Sainte-Justine, Université de Montréal, Montréal, Quebec
| | - Jocelyn Gravel
- Department of Pediatrics Emergency Medicine, CHU Sainte-Justine, Université de Montréal, Montréal, Quebec
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Ganaie MB, Maqsood U, Lea S, Bankart MJ, Bikmalla S, Afridi MA, Khalil MA, Hussain I, Haris M. How should complete lung collapse secondary to primary spontaneous pneumothorax be managed? . Clin Med (Lond) 2019; 19:163-168. [PMID: 30872304 PMCID: PMC6454361 DOI: 10.7861/clinmedicine.19-2-163] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Management of primary spontaneous pneumothorax (PSP) depends on the symptoms and size of lung collapse. The British Thoracic Society recommends needle aspiration (NA) for all PSP requiring intervention, followed by intercostal drain (ICD) if NA fails. We compared the role of NA versus ICD as the first step in PSP with 'complete lung collapse'.This was a retrospective observational study of 877 consecutive pneumothorax episodes at University Hospitals of North Midlands, Stoke on Trent, UK. Chest X-ray (CXR) at presentation was reviewed to identify PSP with complete lung collapse. The primary outcome measure was successful lung re-inflation after initial intervention.Two-hundred and sixty-six PSP patients were identified; 69 had complete lung collapse on CXR of which 35 had NA and 34 had ICD. The ICD group had a significantly better immediate success compared with the NA group (62% versus 11%, odds ratio (OR) = 12.5, p<0.0001; after adjustment for potential confounders, OR increased to 26.4, p=0.0001) although long-term outcomes were comparable.There should be clear consensus on definition and management of complete lung collapse. PSP with complete lung collapse could be managed as a separate subgroup where ICD placement is considered to be the first intervention.
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Affiliation(s)
| | - Usman Maqsood
- Sandwell and West Birmingham Hospitals, West Bromwich, UK
| | - Simon Lea
- Royal Stoke University Hospital, Stoke-on-Trent, UK
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Wang C, Lyu M, Zhou J, Liu Y, Ji Y. Chest tube drainage versus needle aspiration for primary spontaneous pneumothorax: which is better? J Thorac Dis 2017; 9:4027-4038. [PMID: 29268413 DOI: 10.21037/jtd.2017.08.140] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Background Needle aspiration and chest tube drainages are two main treatments for primary spontaneous pneumothorax (PSP). However, the application of needle aspiration or chest tube drainages has not reached a consensus. The aim of this study is to compare the needle aspiration with chest tube drainages in patients suffering with PSP and therefore help offer suggestions for clinical practice. Methods We searched literatures from PubMed, OVID and Web of Science from their inception to June 30, 2017. Continuous and dichotomous outcomes were expressed by weight mean difference (WMD) and risk ratio (RR) respectively, and each with 95% confidence intervals (CIs). We used the fixed effect or random effect model to perform quantitative synthesis. Results A total of 6 RCTs recruiting 458 participants were included in our analysis. On the basis of the six studies, our results indicated that compared with chest tube drainage applying needle aspiration shortened the hospital stay (WMD: ‒1.67 days; 95% CI: ‒2.25 to 1.08; P<0.001) and decreased hospitalization rate (RR: 0.40; 95% CI: 0.22-0.75; P=0.004). However, there was no difference regarding immediate success rate (RR: 1.01; 95% CI: 0.70-1.46; P=0.96) and one-year recurrence rate (RR: 0.89; 95% CI: 0.58-1.38; P=0.61). Conclusions In the light of this present research, it is necessary to apply needle aspiration into treating PSP to reduce hospitalization rate and shorten hospital stay. However, the two treatments have no significant difference with respect to immediate success rate, one-year recurrence rate, one-week success rate, three-month recurrence rate or complication rate.
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Affiliation(s)
- Chengdi Wang
- Department of Respiratory and Critical Care Medicine, West China Medical School/West China Hospital, Sichuan University, Chengdu 610041, China
| | - Mengyuan Lyu
- Department of Laboratory Medicine, West China Medical School/West China Hospital, Sichuan University, Chengdu 610041, China
| | - Jian Zhou
- Department of Thoracic Surgery, West China Medical School/West China Hospital, Sichuan University, Chengdu 610041, China
| | - Yang Liu
- Department of Vascular Surgery, West China Medical School/West China Hospital, Sichuan University, Chengdu 610041, China
| | - Yulin Ji
- Department of Respiratory and Critical Care Medicine, West China Medical School/West China Hospital, Sichuan University, Chengdu 610041, China
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Carson‐Chahhoud KV, Wakai A, van Agteren JEM, Smith BJ, McCabe G, Brinn MP, O'Sullivan R. Simple aspiration versus intercostal tube drainage for primary spontaneous pneumothorax in adults. Cochrane Database Syst Rev 2017; 9:CD004479. [PMID: 28881006 PMCID: PMC6483783 DOI: 10.1002/14651858.cd004479.pub3] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND For management of pneumothorax that occurs without underlying lung disease, also referred to as primary spontaneous pneumothorax, simple aspiration is technically easier to perform than intercostal tube drainage. In this systematic review, we seek to compare the clinical efficacy and safety of simple aspiration versus intercostal tube drainage for management of primary spontaneous pneumothorax. This review was first published in 2007 and was updated in 2017. OBJECTIVES To compare the clinical efficacy and safety of simple aspiration versus intercostal tube drainage for management of primary spontaneous pneumothorax. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2017, Issue 1) in the Cochrane Library; MEDLINE (1966 to January 2017); and Embase (1980 to January 2017). We searched the World Health Organization (WHO) International Clinical Trials Registry for ongoing trials (January 2017). We checked the reference lists of included trials and contacted trial authors. We imposed no language restrictions. SELECTION CRITERIA We included randomized controlled trials (RCTs) of adults 18 years of age and older with primary spontaneous pneumothorax that compared simple aspiration versus intercostal tube drainage. DATA COLLECTION AND ANALYSIS Two review authors independently selected studies for inclusion, assessed trial quality, and extracted data. We combined studies using the random-effects model. MAIN RESULTS Of 2332 publications obtained through the search strategy, seven studies met the inclusion criteria; one study was ongoing and six studies of 435 participants were eligible for inclusion in the updated review. Data show a significant difference in immediate success rates of procedures favouring tube drainage over simple aspiration for management of primary spontaneous pneumothorax (risk ratio (RR) 0.78, 95% confidence interval (CI) 0.69 to 0.89; 435 participants, 6 studies; moderate-quality evidence). Duration of hospitalization however was significantly less for patients treated by simple aspiration (mean difference (MD) -1.66, 95% CI -2.28 to -1.04; 387 participants, 5 studies; moderate-quality evidence). A narrative synthesis of evidence revealed that simple aspiration led to fewer adverse events (245 participants, 3 studies; low-quality evidence), but data suggest no differences between groups in terms of one-year success rate (RR 1.07, 95% CI 0.96 to 1.18; 318 participants, 4 studies; moderate-quality evidence), hospitalization rate (RR 0.60, 95% CI 0.25 to 1.47; 245 participants, 3 studies; very low-quality evidence), and patient satisfaction (median between-group difference of 0.5 on a scale from 1 to 10; 48 participants, 1 study; low-quality evidence). No studies provided data on cost-effectiveness. AUTHORS' CONCLUSIONS Available trials showed low to moderate-quality evidence that intercostal tube drainage produced higher rates of immediate success, while simple aspiration resulted in a shorter duration of hospitalization. Although adverse events were reported more commonly for patients treated with tube drainage, the low quality of the evidence warrants caution in interpreting these findings. Similarly, although this review observed no differences between groups when early failure rate, one-year success rate, or hospital admission rate was evaluated, this too needs to be put into the perspective of the quality of evidence, specifically, for evidence of very low and low quality for hospitalization rate and patient satisfaction, respectively. Future adequately powered research is needed to strengthen the evidence presented in this review.
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Affiliation(s)
- Kristin V Carson‐Chahhoud
- The University of South AustraliaSchool of Health SciencesCity East Campus, Frome RoadAdelaideAustralia5001
| | - Abel Wakai
- Division of Population Health Sciences (PHS), Royal College of Surgeons in Ireland (RCSI)Emergency Care Research Unit (ECRU)123 St. Stephen's GreenDublin 2Ireland
| | | | - Brian J Smith
- The Queen Elizabeth Hospital, Central Adelaide Local Health NetworkRespiratory Medicine UnitAdelaideAustralia
| | - Grainne McCabe
- Royal College of Surgeons in IrelandMercer Library23 St. Stephens Green,DublinIreland2
| | - Malcolm P Brinn
- The University of QueenslandHabit Research Group, School of Public HealthPublic Health Building, Herston RoadHerston RoadBrisbaneQueenslandAustralia4030
| | - Ronan O'Sullivan
- Cork University HospitalCorkIreland
- Our Lady's Children's Hospital CrumlinNational Children's Research CentreDublinIreland12
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Kim MJ, Park I, Park JM, Kim KH, Park J, Shin DW. Systematic review and meta-analysis of initial management of pneumothorax in adults: Intercostal tube drainage versus other invasive methods. PLoS One 2017; 12:e0178802. [PMID: 28640890 PMCID: PMC5480863 DOI: 10.1371/journal.pone.0178802] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 05/18/2017] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES The ideal invasive management as initial approach for pneumothorax (PTX) is still under debate. The purpose of this systematic review and meta-analysis was to examine the evidence for the effectiveness of intercostal tube drainage and other various invasive methods as the initial approach to all subtypes of PTX in adults. METHODS Three databases were searched from inception to May 29, 2016: MEDLINE, EMBASE, and the Cochrane CENTRAL. Randomised controlled trials that evaluated intercostal tube drainage as the control and various invasive methods as the intervention for the initial approach to PTX in adults were included. The primary outcome was the early success rate of each method, and the risk ratios (RRs) were used for an effect size measure. The secondary outcomes were recurrence rate, hospitalization rate, hospital stay, and complications. RESULTS Seven studies met our inclusion criteria. Interventions were aspiration in six studies and catheterization connected to a one-way valve in one study. Meta-analyses were conducted for early success rate, recurrence rate, hospitalization rate, and hospital stay. Aspiration was inferior to intercostal tube drainage in terms of early success rate (RR = 0.82, confidence interval [CI] = 0.72 to 0.95, I2 = 0%). While aspiration and intercostal tube drainage showed no significant difference in the recurrence rate (RR = 0.84, CI = 0.57 to 1.23, I2 = 0%), aspiration had shorter hospital stay than intercostal tube drainage (mean difference = -1.73, CI = -2.33 to -1.13, I2 = 0%). Aspiration had lower hospitalization rate than intercostal tube drainage, but marked heterogeneity was present (RR = 0.38, CI = 0.19 to 0.76, I2 = 85%). CONCLUSION Aspiration was inferior to intercostal tube drainage in terms of early resolution, but it had shorter hospital stay. The recurrence rate of aspiration and intercostal tube drainage did not differ significantly. The efficacy of catheterization connected to a one-way valve was inconclusive because of the small number of relevant studies. (Registration of study protocol: PROSPERO, CRD42016037866).
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Affiliation(s)
- Min Joung Kim
- Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Incheol Park
- Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Joon Min Park
- Department of Emergency Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Kyung Hwan Kim
- Department of Emergency Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Junseok Park
- Department of Emergency Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Dong Wun Shin
- Department of Emergency Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea
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El Jaouhari SD, Mamane Nassirou O, Meziane M, Bensghir M, Haimeur C. [Gas tamponade following intraoperative pneumothorax on a single lung: A case study]. REVUE DE PNEUMOLOGIE CLINIQUE 2017; 73:90-95. [PMID: 28259372 DOI: 10.1016/j.pneumo.2017.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Revised: 12/24/2016] [Accepted: 01/21/2017] [Indexed: 06/06/2023]
Abstract
Intraoperative pneumothorax is a rare complication with a high risk of cardiorespiratory arrest by gas tamponade especially on a single lung. We report the case of a female patient aged 53 years who benefited from a left pneumonectomy on pulmonary tuberculosis sequelae. The patient presented early postoperative anemia with a left hemothorax requiring an emergency thoracotomy. In perioperative, the patient had a gas tamponade following a pneumothorax of the remaining lung, and the fate has been avoided by an exsufflation. Intraoperative pneumothorax can occur due to lesions of the tracheobronchial airway, of the brachial plexus, the placement of a central venous catheter or barotrauma. The diagnosis of pneumothorax during unipulmonary ventilation is posed by the sudden onset of hypoxia associated with increased airway pressures and hypercapnia. The immediate life-saving procedure involves fine needle exsufflation before the placement of a chest tube. Prevention involves reducing the risk of barotrauma by infusing patients with low flow volumes and the proper use of positive airway pressure, knowing that despite protective ventilation, barotraumas risk still exists.
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Affiliation(s)
- S D El Jaouhari
- Pôle anesthesie-réanimation, hôpital militaire d'instruction Mohammed V (HMIMV), faculté de médecine et de pharmacie,université Mohammed V Souissi, Rabat, Maroc.
| | - O Mamane Nassirou
- Pôle anesthesie-réanimation, hôpital militaire d'instruction Mohammed V (HMIMV), faculté de médecine et de pharmacie,université Mohammed V Souissi, Rabat, Maroc
| | - M Meziane
- Pôle anesthesie-réanimation, hôpital militaire d'instruction Mohammed V (HMIMV), faculté de médecine et de pharmacie,université Mohammed V Souissi, Rabat, Maroc
| | - M Bensghir
- Pôle anesthesie-réanimation, hôpital militaire d'instruction Mohammed V (HMIMV), faculté de médecine et de pharmacie,université Mohammed V Souissi, Rabat, Maroc
| | - C Haimeur
- Pôle anesthesie-réanimation, hôpital militaire d'instruction Mohammed V (HMIMV), faculté de médecine et de pharmacie,université Mohammed V Souissi, Rabat, Maroc
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Is it possible to standardize the treatment of primary spontaneous pneumothorax? Part 1: etiology, symptoms, diagnostics, minimally invasive treatment. POLISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2017; 13:322-327. [PMID: 28096829 PMCID: PMC5233762 DOI: 10.5114/kitp.2016.64874] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Accepted: 11/16/2016] [Indexed: 11/25/2022]
Abstract
The authors of this report present the history of primary spontaneous pneumothorax (PSP) treatment, its etiology, clinical symptoms, and diagnostic methodology. Further, they discuss minimally invasive methods of treating PSP such as thoracentesis and chemical pleurodesis. They discuss the pros and cons of each method, emphasizing that, according to the international recommendations, they should be used as the first line of treatment for PSP.
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Abstract
Pneumothorax is defined as the abnormal presence of air within the pleural space (cavity) that results in the partial or complete collapse of a lung. It can occur spontaneously or due to a traumatic event. Symptoms can vary from a nondescriptive complaint of shortness of breath or chest pain to complete cardiopulmonary collapse. Diagnosis is based on a combination of clinical suspicion along with supporting imaging studies. Treatment often involves surgical or nonsurgical approaches with goal to alleviate symptoms and prevent recurrence.
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Wu KK, Lui CT, Ho CL, Tsui KL, Fung HT. Presenting hydrothorax predicts failure of needle aspiration in primary spontaneous pneumothorax. Am J Emerg Med 2016; 34:1075-9. [PMID: 27037132 DOI: 10.1016/j.ajem.2016.03.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Revised: 03/08/2016] [Accepted: 03/08/2016] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE The objective was to evaluate if existence of hydrothorax in initial chest radiograph predicts treatment outcome in patients with primary spontaneous pneumothorax who received needle thoracostomy. METHODS This is a retrospective cohort study carried out from January 2011 to August 2014 in 1 public hospital in Hong Kong. All consecutive adult patients aged 18years or above who attended the emergency department with the diagnosis of primary spontaneous pneumothorax with needle aspiration performed as primary treatment were included. Age, smoking status, size of pneumothorax, previous history of pneumothorax, aspirated gas volume and presence of hydropneumothorax in initial radiograph were included in the analysis. The outcome was success or failure of the needle aspiration. Logistic regression was used to identify the predicting factors of failure of needle aspiration. RESULT There were a total of 127 patients included. Seventy-three patients (57.5%) were successfully treated with no recurrence upon discharge. Among 54 failure cases, 13 patients (10.2%) failed immediately after procedure as evident by chest radiograph and required second treatment. Forty-one patients (32.3%) failed upon subsequent chest radiographs. Multivariate logistic regression showed factors independently associated with the failure of needle aspiration, which included hydropneumothorax in the initial radiograph (odds ratio [OR]=4.47 [1.56i12.83], P=.005), previous history of pneumothorax (OR=3.92 [1.57-9.79], P=.003), and large size of pneumothorax defined as apex-to-cupola distance ≥5cm (OR=2.75 [1.21-6.26], P=.016). CONCLUSIONS Hydropneumothorax, previous history of pneumothorax, and large size were independent predictors of failure of needle aspiration in treatment of primary spontaneous pneumothorax.
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Abstract
Undifferentiated patients in respiratory distress require immediate attention in the emergency department. Using a thorough history and clinical examination, clinicians can determine the most likely causes of dyspnea. Understanding the pathophysiology of the most common diseases contributing to dyspnea guides rational testing and informed, expedited treatment decisions.
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Affiliation(s)
- Elizabeth DeVos
- Department of Emergency Medicine, University of Florida College of Medicine - Jacksonville, 655 West 8th Street, Jacksonville, FL 32209, USA
| | - Lisa Jacobson
- Department of Emergency Medicine, University of Florida College of Medicine - Jacksonville, 655 West 8th Street, Jacksonville, FL 32209, USA.
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17
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Spontaneous pneumothorax in children - management, results, and review of the literature. POLISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2015; 12:322-7. [PMID: 26855648 PMCID: PMC4735533 DOI: 10.5114/kitp.2015.56782] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Accepted: 09/15/2015] [Indexed: 12/02/2022]
Abstract
Introduction Primary spontaneous pneumothorax (PSP) occurs at a frequency of 7.4-18 cases per 100 000 population per year. The PSP typically occurs in young adults and is uncommon in children. The aim of this study was to review our institutional experience with PSP in children. Material and methods Twenty-two paediatric patients with confirmed PSP, treated from 2004 to 2014 at the Paediatric Surgery Clinic. There were 18 boys and 4 girls. The mean age was 16 years, 6 months ± 1 month (range 14-17). The mean body mass index (BMI) was 20.1 (ranging from 17 to 24). Results The recurrence rate of PSP was 48%. The mean interval of the recurrence was 5 months ± 1 month (range from 3 weeks to 2 years). Recurrent pneumothorax was evacuated by thoracostomy with success in four patients. The first video-assisted thoracoscopic surgery (VATS) procedure had a failure rate of 50%. After second VATS procedure, we did not observe recurrent PSP in two patients. One patient with recurrent PSP, after two VATS procedures, was treated with success, with an open mini axillary thoracotomy. The mean follow-up period was 4 years 3 months ± 1 month (range 6 months – 10 years). We have not noted any intraoperative complications. Conclusions Although our study is limited by the small number of patients, we conclude that most patients resolve their spontaneous pneumothorax and air leak with tube thoracostomy alone. For those patients in whom chest tube drainage is not effective, and for those with recurrent PSP, early VATS and bullectomy combined with pleural abrasion is the most efficient intervention.
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Tschopp JM, Bintcliffe O, Astoul P, Canalis E, Driesen P, Janssen J, Krasnik M, Maskell N, Van Schil P, Tonia T, Waller DA, Marquette CH, Cardillo G. ERS task force statement: diagnosis and treatment of primary spontaneous pneumothorax. Eur Respir J 2015; 46:321-35. [PMID: 26113675 DOI: 10.1183/09031936.00219214] [Citation(s) in RCA: 205] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Accepted: 03/17/2015] [Indexed: 12/15/2022]
Abstract
Primary spontaneous pneumothorax (PSP) affects young healthy people with a significant recurrence rate. Recent advances in treatment have been variably implemented in clinical practice. This statement reviews the latest developments and concepts to improve clinical management and stimulate further research.The European Respiratory Society's Scientific Committee established a multidisciplinary team of pulmonologists and surgeons to produce a comprehensive review of available scientific evidence.Smoking remains the main risk factor of PSP. Routine smoking cessation is advised. More prospective data are required to better define the PSP population and incidence of recurrence. In first episodes of PSP, treatment approach is driven by symptoms rather than PSP size. The role of bullae rupture as the cause of air leakage remains unclear, implying that any treatment of PSP recurrence includes pleurodesis. Talc poudrage pleurodesis by thoracoscopy is safe, provided calibrated talc is available. Video-assisted thoracic surgery is preferred to thoracotomy as a surgical approach.In first episodes of PSP, aspiration is required only in symptomatic patients. After a persistent or recurrent PSP, definitive treatment including pleurodesis is undertaken. Future randomised controlled trials comparing different strategies are required.
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Affiliation(s)
- Jean-Marie Tschopp
- Centre Valaisan de Pneumologie, Dept of Internal Medicine RSV, Montana, Switzerland Task Force Chairs
| | - Oliver Bintcliffe
- Academic Respiratory Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Philippe Astoul
- Dept of Thoracic Oncology, Pleural Diseases and Interventional Pulmonology, Hospital North Aix-Marseille University, Marseille, France
| | - Emilio Canalis
- Dept of Surgery, University of Rovira I Virgili, Tarragona, Spain
| | | | - Julius Janssen
- Dept of Pulmonary Diseases, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Marc Krasnik
- Dept of Cardiothoracic Surgery, Rigshospitalet, Copenhagen, Denmark
| | - Nicholas Maskell
- Academic Respiratory Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Paul Van Schil
- Dept of Thoracic and Vascular Surgery, Antwerp University Hospital, Antwerp, Belgium
| | - Thomy Tonia
- Institute of Social and Preventative Medicine, University of Bern, Bern, Switzerland
| | - David A Waller
- Dept of Thoracic Surgery, Glenfield Hospital, Leicester, UK
| | - Charles-Hugo Marquette
- Hospital Pasteur CHU Nice and Institute for Research on Cancer and Ageing, University of Nice Sophia Antipolis, Nice, France
| | - Giuseppe Cardillo
- Dept of Thoracic Surgery, Carlo Forlanini Hospital, Azienda Ospedaliera San Camillo Forlanini, Rome, Italy Task Force Chairs
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Brown SGA, Ball EL, Macdonald SPJ, Wright C, McD Taylor D. Spontaneous pneumothorax; a multicentre retrospective analysis of emergency treatment, complications and outcomes. Intern Med J 2015; 44:450-7. [PMID: 24612237 DOI: 10.1111/imj.12398] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Accepted: 02/15/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Spontaneous pneumothorax can be managed initially by observation, aspiration or chest drain insertion. AIMS To determine the clinical features of spontaneous pneumothorax in patients presenting to the emergency department (ED), interventions, outcomes and potential risk factors for poor outcomes after treatment. METHODS Retrospective chart review from ED of three major referral and two general hospitals in Australia of presentations with primary spontaneous pneumothorax (PSP) or secondary spontaneous pneumothorax (SSP). Main outcomes were prolonged air leak (>5 days) and pneumothorax recurrence within 1 year. RESULTS We identified 225 people with PSP and 98 with SSP. There were no clinical tension pneumothoraces with hypotension. Hypoxaemia (haemoglobin oxygen saturation measured by pulse oximetry ≤92%) occurred only in SSP and in older patients (age >50 years) with PSP. Drainage was performed in 150 (67%) PSP and 82 (84%) SSP. Prolonged air leak occurred in 16% (95% confidence interval 10-23%) of PSP and 31% (21-42%) of SSP. Independent risk factors for prolonged drainage were non-asthma SSP and pneumothorax size >50%. Complications were recorded in 11% (7.5-16%) of those having drains inserted. Recurrences occurred in 5/91 (5%, 1.8-12%) of those treated without drainage versus 40/232 (17%, 13-23%) of those treated by drainage, of which half occurred in the first month after drainage. CONCLUSION Pneumothorax drainage is associated with substantial morbidity including prolonged air leak. As PSP appears to be well tolerated in younger people even with large pneumothoraces, conservative treatment in this subgroup may be a viable option to improve patient outcomes, but this needs to be confirmed in a clinical trial.
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Affiliation(s)
- S G A Brown
- Centre for Clinical Research in Emergency Medicine, Harry Perkins Institute of Medical Research, Perth, Western Australia, Australia; Department of Emergency Medicine, Royal Perth Hospital, Perth, Western Australia, Australia; Emergency Medicine, University of Western Australia, Perth, Western Australia, Australia
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20
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Comparison of Small Bore Catheter Aspiration and Chest Tube Drainage in the Management of Spontaneous Pneumothorax. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2015; 866:15-23. [DOI: 10.1007/5584_2015_146] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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21
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It Takes a System to Treat a Pneumothorax. Ann Emerg Med 2014; 64:229-30. [DOI: 10.1016/j.annemergmed.2014.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Revised: 01/07/2014] [Accepted: 01/08/2014] [Indexed: 11/21/2022]
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22
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Voisin F, Sohier L, Rochas Y, Kerjouan M, Ricordel C, Belleguic C, Desrues B, Jouneau S. Ambulatory Management of Large Spontaneous Pneumothorax With Pigtail Catheters. Ann Emerg Med 2014; 64:222-8. [DOI: 10.1016/j.annemergmed.2013.12.017] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2013] [Revised: 12/02/2013] [Accepted: 12/10/2013] [Indexed: 10/25/2022]
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23
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Tupchong K, Foran M, Koyfman A. Can Heimlich valves along with intercostal catheters be used to safely manage pneumothoraces for outpatients? Ann Emerg Med 2014; 64:660-1. [PMID: 24882664 DOI: 10.1016/j.annemergmed.2014.05.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2014] [Revised: 05/07/2014] [Accepted: 05/07/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Keegan Tupchong
- Department of Emergency Medicine, New York University School of Medicine, Bellevue Hospital Center, New York, NY
| | - Mark Foran
- Department of Emergency Medicine, New York University School of Medicine, Bellevue Hospital Center, New York, NY
| | - Alex Koyfman
- Division of Emergency Medicine, UT Southwestern Medical Center/Parkland Memorial Hospital, Dallas, TX
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Pasquier M, Hugli O, Carron PN. Videos in clinical medicine. Needle aspiration of primary spontaneous pneumothorax. N Engl J Med 2013; 368:e24. [PMID: 23656667 DOI: 10.1056/nejmvcm1111468] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Abstract
Children comprise approximately one-quarter of all visits to most emergency departments. Children are generally healthier than adults, yet there are similar priorities in assessment and management of pediatric patients. The initial approach to airway, breathing, and circulation still applies and is first and foremost in the evaluation of young infants and children. There are certain anatomic, physiologic, developmental, and social considerations that are unique to this population and must be taken into account during their evaluation and treatment. In this review, we present and discuss an evidence-based approach to high-yield procedures necessary for all emergency physicians taking care of children.
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Affiliation(s)
- Fernando Soto
- Pediatric Emergency Medicine Section, University of Puerto Rico School of Medicine, PO Box 29207, San Juan, PR 00929, USA.
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Repanshek ZD, Ufberg JW, Vilke GM, Chan TC, Harrigan RA. Alternative Treatments of Pneumothorax. J Emerg Med 2013; 44:457-66. [DOI: 10.1016/j.jemermed.2012.02.049] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2011] [Revised: 02/23/2012] [Accepted: 02/25/2012] [Indexed: 10/28/2022]
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27
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Cha KC, Kim H, Ji HJ, Kwon WC, Shin HJ, Cha YS, Lee KH, Hwang SO, Lee CC, Singer AJ. The frequency of reexpansion pulmonary edema after trocar and hemostat assisted thoracostomy in patients with spontaneous pneumothorax. Yonsei Med J 2013; 54:166-71. [PMID: 23225814 PMCID: PMC3521265 DOI: 10.3349/ymj.2013.54.1.166] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
PURPOSE Several risk factors for development of reexpansion pulmonary edema (REPE) after drainage of pneumothoraces have been reported, but the association between the method of thoracostomy and the development of REPE is unknown. The aim of this study was to compare the frequency of REPE after treatment of spontaneous pneumothorax with trocar or hemostat assisted closed thoracostomy. MATERIALS AND METHODS We performed a prospective, observational study including 173 patients with spontaneous pneumothorax who visited the emergency department from January 2007 to December 2008. In 2007, patients were treated with hemostat-assisted drainage, whereas patients in 2008 were treated with trocar-assisted drainage. The main outcome was the development of REPE, determined by computed tomography of the chest 8 hours after closed thoracostomy. Outcomes in both groups were compared using univariate and multivariate analyses. RESULTS Ninety-two patients were included, 48 (42 males) of which underwent hemostat-assisted drainage and 44 (41 males) underwent trocar-assisted drainage. The groups were similar in mean age (24 ± 10 vs. 26 ± 14 respectively). The frequencies of REPE after hemostat- and trocar-assisted drainage were 63% (30 patients) and 86% (38 patients) respectively (p=0.009). In multivariate analysis, trocar-assisted drainage was the major contributing factor for developing REPE (odds ratio=5.7, 95% confidence interval, 1.5-21). Age, gender, size of pneumothorax, symptom duration and laboratory results were similar between the groups. CONCLUSION Closed thoracostomy using a trocar is associated with an increased risk of REPE compared with hemostat- assisted drainage in patients with spontaneous pneumothorax.
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Affiliation(s)
- Kyoung Chul Cha
- Department of Emergency Medicine, Wonju College of Medicine, Yonsei University, Wonju, Korea
| | - Hyun Kim
- Department of Emergency Medicine, Wonju College of Medicine, Yonsei University, Wonju, Korea
| | - Ho Jin Ji
- Department of Emergency Medicine, Andong Hospital, Andong, Korea
| | - Woo Cheol Kwon
- Department of Radiology, Wonju College of Medicine, Yonsei University, Wonju, Korea
| | - Hyung Jin Shin
- Department of Emergency Medicine, Wonju College of Medicine, Yonsei University, Wonju, Korea
| | - Yong Sung Cha
- Department of Emergency Medicine, Wonju College of Medicine, Yonsei University, Wonju, Korea
| | - Kang Hyun Lee
- Department of Emergency Medicine, Wonju College of Medicine, Yonsei University, Wonju, Korea
| | - Sung Oh Hwang
- Department of Emergency Medicine, Wonju College of Medicine, Yonsei University, Wonju, Korea
| | - Christopher C. Lee
- Department of Emergency Medicine, Stony Brook University Hospital, Stony Brook, NY, USA
| | - Adam J. Singer
- Department of Emergency Medicine, Stony Brook University Hospital, Stony Brook, NY, USA
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Kaneda H, Nakano T, Taniguchi Y, Saito T, Konobu T, Saito Y. Three-step management of pneumothorax: time for a re-think on initial management. Interact Cardiovasc Thorac Surg 2012; 16:186-92. [PMID: 23117233 DOI: 10.1093/icvts/ivs445] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Pneumothorax is a common disease worldwide, but surprisingly, its initial management remains controversial. There are some published guidelines for the management of spontaneous pneumothorax. However, they differ in some respects, particularly in initial management. In published trials, the objective of treatment has not been clarified and it is not possible to compare the treatment strategies between different trials because of inappropriate evaluations of the air leak. Therefore, there is a need to outline the optimal management strategy for pneumothorax. In this report, we systematically review published randomized controlled trials of the different treatments of primary spontaneous pneumothorax, point out controversial issues and finally propose a three-step strategy for the management of pneumothorax. There are three important characteristics of pneumothorax: potentially lethal respiratory dysfunction; air leak, which is the obvious cause of the disease; frequent recurrence. These three characteristics correspond to the three steps. The central idea of the strategy is that the lung should not be expanded rapidly, unless absolutely necessary. The primary objective of both simple aspiration and chest drainage should be the recovery of acute respiratory dysfunction or the avoidance of respiratory dysfunction and subsequent complications. We believe that this management strategy is simple and clinically relevant and not dependent on the classification of pneumothorax.
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Affiliation(s)
- Hiroyuki Kaneda
- Department of Thoracic and Cardiovascular Surgery, Division of Thoracic Surgery, Kansai Medical University Hirakata Hospital, Osaka, Japan.
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29
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Spontaneous resolution of a large traumatic pneumothorax. Am J Emerg Med 2012; 30:833.e3-5. [PMID: 21530135 DOI: 10.1016/j.ajem.2011.02.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2011] [Accepted: 02/21/2011] [Indexed: 11/23/2022] Open
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Maybauer MO, Geisser W, Wolff H, Maybauer DM. Incidence and outcome of tube thoracostomy positioning in trauma patients. PREHOSP EMERG CARE 2011; 16:237-41. [PMID: 21967410 DOI: 10.3109/10903127.2011.615975] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES To evaluate the frequency of use, placement site, success and misplacement rates, and need for intervention for tube thoracostomies (TTs), and the complications with endotracheal intubation associated with TT in the prehospital setting. METHODS We performed a five-year, retrospective study using the records of 1,065 patients who were admitted to the trauma emergency room at a university hospital and who had received chest radiographs or computed tomography (CT) scans within 30 minutes after admission. RESULTS Seven percent of all patients received a TT (5% unilateral, 2% bilateral). Ninety-seven percent of all patients with a TT were endotracheally intubated. The success rate for correctly placed chest tubes was 78%. Twenty-two percent of the chest tubes were misplaced (i.e., too far in the chest, twisted, or bent); half of those had to be corrected, with one needing to be replaced. There were no statistical differences in the frequency of Monaldi or Bülau positions, or the frequency of left or right chest TT. In addition, the two positions did not differ in misplacement rates or the need for intervention. Helicopter emergency medical services physicians used the Monaldi position significantly more frequently than the Bülau position. In-hospital physicians performing interhospital transfer used the Bülau position significantly more frequently, whereas ground emergency medical physicians had a more balanced relationship between the two positions. Tube thoracostomy had no influence on endotracheal tube misplacement rates, and vice versa. CONCLUSION Tube thoracostomy positioning mostly depends on the discretion of the physician on scene. The Monaldi and Bülau positions do not differ in misplacement or complication rates.
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Affiliation(s)
- Marc O Maybauer
- Department of Anaesthesiology, University Hospital at Ulm, Germany.
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31
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Kuan WS, Lather KS, Mahadevan M. Primary spontaneous pneumothorax—the role of the emergency observation unit. Am J Emerg Med 2011; 29:293-8. [DOI: 10.1016/j.ajem.2009.11.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2009] [Revised: 10/31/2009] [Accepted: 11/02/2009] [Indexed: 10/19/2022] Open
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32
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Luh SP. Review: Diagnosis and treatment of primary spontaneous pneumothorax. J Zhejiang Univ Sci B 2011; 11:735-44. [PMID: 20872980 DOI: 10.1631/jzus.b1000131] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Primary spontaneous pneumothorax (PSP) commonly occurs in tall, thin, adolescent men. Though the pathogenesis of PSP has been gradually uncovered, there is still a lack of consensus in the diagnostic approach and treatment strategies for this disorder. Herein, the literature is reviewed concerning mechanisms and personal clinical experience with PSP. The chest computed tomography (CT) has been more commonly used than before to help understand the pathogenesis of PSP and plan further management strategies. The development of video-assisted thoracoscopic surgery (VATS) has changed the profiles of management strategies of PSP due to its minimal invasiveness and high effectiveness for patients with these diseases.
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Affiliation(s)
- Shi-ping Luh
- Department of Surgery, St. Martin de Porres Hospital, Chia-Yi City 60069, Taiwan, China.
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Yadav K, Jalili M, Zehtabchi S. Management of traumatic occult pneumothorax. Resuscitation 2010; 81:1063-8. [PMID: 20619952 DOI: 10.1016/j.resuscitation.2010.04.030] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2010] [Accepted: 04/26/2010] [Indexed: 11/19/2022]
Abstract
STUDY OBJECTIVE Occult pneumothorax (OPTX) is defined as a pneumothorax seen on computed tomography but not apparent on supine plain radiography. Though increasingly common, the acute management of OPTX after trauma remains controversial. This evidence-based review evaluates the existing evidence regarding the safety and efficacy of observation as compared to tube thoracostomy (TT) for management of OPTX in emergency department trauma patients. METHODS The authors searched MEDLINE, EMBASE, the Cochrane Library, and other databases. INCLUSION CRITERIA studies of adult or pediatric trauma victims at first presentation after blunt or penetrating injury (population), randomized to observation (intervention) or TT (comparison). Studies that enrolled patients on positive pressure ventilation were included but those that enrolled hemodynamically unstable patients were excluded. Outcomes of interest included progression of OPTX, mortality, complications (pneumonia, empyema), and length of stay in hospital and intensive care unit (ICU). RESULTS A total of 411 articles were identified. After applying the inclusion/exclusion criteria, 3 randomized trials enrolling a total of 101 patients were found to have acceptable quality standards suitable for analysis. The included studies did not reveal any significant difference between observation and TT in regards to progression of OPTX, risk of pneumonia, or length of stay in hospital or ICU. Mortality risk and empyema rate were also not different in the single studies that reported those outcomes. CONCLUSION The existing evidence leads to the conclusion that observation is at least as safe and effective as tube thoracostomy for management of occult pneumothorax.
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Affiliation(s)
- Kabir Yadav
- The George Washington University Medical Center, Department of Emergency Medicine, Washington, DC, USA.
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Affiliation(s)
- Ethan S Brandler
- Department of Emergency Medicine SUNY Downstate/Kings County Hospital Center Brooklyn, NY, USA.
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Wills CP, Young M, White DW. Pitfalls in the evaluation of shortness of breath. Emerg Med Clin North Am 2010; 28:163-81, ix. [PMID: 19945605 DOI: 10.1016/j.emc.2009.09.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This article illustrates the challenges practitioners face evaluating shortness of breath, a common emergency department complaint. Through a series of patient encounters, pitfalls in the evaluation of shortness of breath are reviewed and discussed.
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Affiliation(s)
- Charlotte Page Wills
- Department of Emergency Medicine, Alameda County Medical Center-Highland Hospital, 1411 East 31st Street, Oakland, CA 94602, USA.
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