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Yanik F, Karamustafaoglu YA, Yoruk Y. Outcomes of Non-intubated Versus Intubated Thoracoscopic Surgery for Primary Spontaneous Pneumothorax. Surg Laparosc Endosc Percutan Tech 2023; 33:487-492. [PMID: 37585394 DOI: 10.1097/sle.0000000000001213] [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: 05/11/2023] [Accepted: 07/11/2023] [Indexed: 08/18/2023]
Abstract
BACKGROUND This study aimed to compare the outcomes of non-intubated video-assisted thoracic surgery (N-VATS) and intubated video-assisted thoracic surgery (I-VATS) for primary spontaneous pneumothorax (PSP). MATERIALS AND METHODS We retrospectively analyzed 120 consecutive patients who underwent VATS for PSP. The patients were divided into N-VATS and I-VATS groups. Demographics, clinical characteristics, postoperative results, pain scores, follow-up results, and management were evaluated and compared between the groups. Local anesthesia and deep sedation (ketamine 2 mg/kg IV and propofol 2 mg/kg IV slow infusion) were administered under spontaneous ventilation in the N-VATS group. RESULTS The groups did not differ significantly in terms of age, sex, American Society of Anesthesiology score, pneumothorax side, or smoking history ( P >0.05). The mean operation time, anesthesia time, oral intake opening time, and mobilization time were significantly shorter in the N-VATS group (26.04±4.61 vs. 48.26±7.82 min, 42.14±6.40 vs. 98.16±12.4 min, 2.1±0.4 vs. 8.4±1.2 h, and 4.2±0.9 vs. 2.6±1.4 between N-VATS and I-VATS, respectively; P <0.05). The surgical outcomes did not differ in terms of minor complications (12%-13%) and recurrence rates (5.1%-6.4%) during a mean follow-up period of 88.4±10.2 mo. No cases of conversion to open surgery or mortality were observed. General anesthesia and intubation were not required for any patient in the N-VATS group. CONCLUSIONS Our results revealed no differences in minor complications or recurrence rates between groups. However, the N-VATS group had significantly shorter operation, anesthesia, oral intake opening, and mobilization times. The most important advantage of N-VATS for PSP is its fast recovery while avoiding the risks of general anesthesia and intubation. Further prospective studies with larger sample sizes are warranted.
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Affiliation(s)
- Fazli Yanik
- Department of Thoracic Surgery, Trakya University Faculty of Medicine, Edirne, Turkey
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Marx T, Joly LM, Parmentier AL, Pretalli JB, Puyraveau M, Meurice JC, Schmidt J, Tiffet O, Ferretti G, Lauque D, Honnart D, Al Freijat F, Dubart AE, Grandpierre RG, Viallon A, Perdu D, Roy PM, El Cadi T, Bronet N, Duncan G, Cardot G, Lestavel P, Mauny F, Desmettre T. Simple Aspiration versus Drainage for Complete Pneumothorax: A Randomized Noninferiority Trial. Am J Respir Crit Care Med 2023; 207:1475-1485. [PMID: 36693146 DOI: 10.1164/rccm.202110-2409oc] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 01/24/2023] [Indexed: 01/26/2023] Open
Abstract
Rationale: Management of first episodes of primary spontaneous pneumothorax remains the subject of debate. Objectives: To determine whether first-line simple aspiration is noninferior to first-line chest tube drainage for lung expansion in patients with complete primary spontaneous pneumothorax. Methods: We conducted a prospective, open-label, randomized noninferiority trial. Adults aged 18-50 years with complete primary spontaneous pneumothorax (total separation of the lung from the chest wall), recruited at 31 French hospitals from 2009 to 2015, received simple aspiration (n = 200) or chest tube drainage (n = 202) as first-line treatment. The primary outcome was pulmonary expansion 24 hours after the procedure. Secondary outcomes were tolerance of treatment, occurrence of adverse events, and recurrence of pneumothorax within 1 year. Substantial discordance in the numerical inputs used for trial planning and the actual trial rates of the primary outcome resulted in a reevaluation of the trial analysis plan. Measurement and Main Results: Treatment failure occurred in 29% in the aspiration group and 18% in the chest tube drainage group (difference in failure rate, 0.113; 95% confidence interval [CI], 0.026-0.200). The aspiration group experienced less pain overall (mean difference, -1.4; 95% CI, -1.89, -0.91), less pain limiting breathing (frequency difference, -0.18; 95% CI, -0.27, -0.09), and less kinking of the device (frequency difference, -0.05; 95% CI, -0.09, -0.01). Recurrence of pneumothorax was 20% in this group versus 27% in the drainage group (frequency difference, -0.07; 95% CI, -0.16, +0.02). Conclusions: First-line management of complete primary spontaneous pneumothorax with simple aspiration had a higher failure rate than chest tube drainage but was better tolerated with fewer adverse events. Clinical trial registered with www.clinicaltrials.gov (NCT01008228).
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Affiliation(s)
| | - Luc-Marie Joly
- Service d'accueil des urgences, Centre hospitalier universitaire de Rouen, Rouen, France
| | | | - Jean-Baptiste Pretalli
- Centre Investigation Clinique INSERM 1431, Centre hospitalier universitaire de Besançon, Besançon, France
| | | | - Jean-Claude Meurice
- Service de pneumologie, Centre hospitalier universitaire de Poitiers, Poitiers, France
| | - Jeannot Schmidt
- Service d'accueil des urgences, Centre hospitalier universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | | | - Gilbert Ferretti
- Service de radiologie diagnostic et thérapeutique, Centre hospitalier universitaire de Grenoble, Grenoble, France
| | | | - Didier Honnart
- Service d'accueil des urgences, Centre hospitalier universitaire de Dijon, Dijon, France
| | - Faraj Al Freijat
- Service de pneumologie, Hôpital Nords Franche-Comté, Trévenans, France
| | - Alain Eric Dubart
- Service d'accueil des urgences, Centre hospitalier de Béthune, Béthune, France
| | - Romain Genre Grandpierre
- Service d'anesthésie et soins intensifs, Centre hospitalier universitaire de Nîmes, Nîmes, France
| | - Alain Viallon
- Service d'accueil des urgences, Centre hospitalier universitaire de Saint-Etienne, Saint-Etienne, France
| | - Dominique Perdu
- Service de pneumologie, Centre hospitalier universitaire de Reims, Reims, France
| | - Pierre Marie Roy
- Service d'accueil des urgences, Centre hospitalier universitaire d'Angers, Angers, France
| | - Toufiq El Cadi
- Service d'accueil des urgences, Groupe hospitalier de la Haute-Saône, Vesoul, France
| | - Nathalie Bronet
- Service d'accueil des urgences, Centre hospitalier Saint-Philibert-GHICL, Lomme, France
| | - Grégory Duncan
- Service d'accueil des urgences, Centre hospitalier Boulogne-sur-Mer, Boulogne-sur-Mer, France
| | - Gilles Cardot
- Service de chirurgie thoracique, Centre hospitalier Duchenne, Boulogne-sur-Mer, France; and
| | - Philippe Lestavel
- Service de soins intensifs, Polyclinique de Hénin-Beaumont, Hénin-Beaumont, France
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Villgran VD, Lyons C, Nasrullah A, Clarisse Abalos C, Bihler E, Alhajhusain A. Acute Respiratory Failure. Crit Care Nurs Q 2022; 45:233-247. [PMID: 35617090 DOI: 10.1097/cnq.0000000000000408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Respiratory failure is one of the most common reasons for hospitalization and intensive care unit (ICU) admissions, and a diverse range of etiologies can precipitate it. Respiratory failure can result from various mechanisms such as hypoventilation, diffusion impairment, shunting, ventilation-perfusion mismatch, or a combination of those mentioned earlier. Hence, an accurate understanding of different pathophysiologic mechanisms is required for appropriate patient care. Prompt identification and treatment of various respiratory emergencies such as tension pneumothorax, massive hemoptysis, and high-risk pulmonary embolism lead to fewer complications, shorter ICU and hospital stay, and improved survival. This review article entails common respiratory failure pathologies encountered in the ICU and addresses their epidemiology, pathophysiology, clinical presentation, and management.
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Affiliation(s)
- Vipin Das Villgran
- Division of Pulmonary and Critical Care Medicine, Allegheny Health Network, Pittsburgh, Pennsylvania (Drs Villgran, Nasrullah, Abalos, Bihler, and Alhajhusain); and Department of Nursing, Allegheny General Hospital, Allegheny Health Network, Pittsburgh, Pennsylvania (Ms Lyons)
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Abstract
Pneumothorax is a common problem worldwide. Pneumothorax develops secondary to diverse aetiologies; in many cases, there may be no recognizable lung abnormality. The pathogenetic mechanism(s) causing spontaneous pneumothorax may be related to an interplay between lung-related abnormalities and environmental factors such as smoking. Tobacco smoking is a major risk factor for primary spontaneous pneumothorax; chronic obstructive pulmonary disease is most frequently associated with secondary spontaneous pneumothorax. This review article provides an overview of the historical perspective, epidemiology, classification, and aetiology of pneumothorax. It also aims to highlight current knowledge and understanding of underlying risks and pathophysiological mechanisms in pneumothorax development.
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Affiliation(s)
- Nai-Chien Huan
- Department of Pulmonology, Serdang Hospital, Kajang, Malaysia
| | - Calvin Sidhu
- Edith Cowan University, Perth, Australia; Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, Australia
| | - Rajesh Thomas
- Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, Australia; School of Medicine, University of Western Australia, Perth, Australia.
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Brophy S, Brennan K, French D. Recurrence of primary spontaneous pneumothorax following bullectomy with pleurodesis or pleurectomy: A retrospective analysis. J Thorac Dis 2021; 13:1603-1611. [PMID: 33841952 PMCID: PMC8024846 DOI: 10.21037/jtd-20-3257] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background Primary spontaneous pneumothorax is managed initially with observation and chest tube placement, followed by surgical intervention in select cases. With little currently published evidence, the role of surgical pleurodesis or pleurectomy to reduce primary spontaneous pneumothorax recurrence is unclear. This study compares the recurrence rates of primary spontaneous pneumothorax following bullectomy alone versus bullectomy with pleurodesis or pleurectomy. Methods A retrospective review was performed at a quaternary hospital for all patients undergoing surgery for primary spontaneous pneumothorax between June 2006 and December 2018. Patient demographics, disease severity, operative technique, and time between initial surgery and recurrence were recorded. Standard statistical techniques were used for univariable and multivariable analyses. Results Of 222 total included patients, 28 required a second surgery: 4 (1.8%) for prolonged air leak and 24 (10.8%) for recurrent pneumothorax. The median time from first to second surgery was 363 days and 35.7% of recurrences did not present until after two years. Age, sex, smoking, year of initial surgery, disease severity, and surgical technique did not significantly affect recurrence rate on univariable analysis. On multivariable analysis, the odds ratios of recurrence for bullectomy with mechanical pleurodesis or pleurectomy were respectively 0.82 and 0.15 (P=0.218), compared to bullectomy alone. Combined bullectomy, pleurectomy, and pleurodesis was most effective (0/18, 0%). Conclusions Bullectomy with pleurectomy and pleurodesis demonstrated a 0% recurrence rate for the treatment of primary spontaneous pneumothorax in this study. Statistical significance was not achieved in univariable or multivariable analyses comparing recurrence rates for the surgical approaches. A multi-center randomized controlled trial with longer follow-up than previously performed is needed to confirm these preliminary findings and optimize surgical management of primary spontaneous pneumothorax.
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Affiliation(s)
- Shawn Brophy
- Division of General Surgery, Department of Surgery, Dalhousie University, Queen Elizabeth II Hospital - Victoria Campus, Halifax, NS, Canada
| | - Kelly Brennan
- Dalhousie Medical School, Department of Surgery, Dalhousie University, Queen Elizabeth II Hospital - Victoria Campus, Halifax, NS, Canada
| | - Daniel French
- Division of Thoracic Surgery, Department of Surgery, Dalhousie University, Queen Elizabeth II Hospital - Victoria Campus, Halifax, NS, Canada
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Ruigrok D, Kunst PWA, Blacha MMJ, Tomlow B, Herbrink JW, Japenga EJ, Boersma W, Bresser P, van der Lee I, Mooren K. Digital versus analogue chest drainage system in patients with primary spontaneous pneumothorax: a randomized controlled trial. BMC Pulm Med 2020; 20:136. [PMID: 32393220 PMCID: PMC7216363 DOI: 10.1186/s12890-020-1173-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Accepted: 04/29/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patients with a primary spontaneous pneumothorax (PSP) who are treated with chest tube drainage are traditionally connected to an analogue chest drainage system, containing a water seal and using a visual method of monitoring air leakage. Electronic systems with continuous digital monitoring of air leakage provide better insight into actual air leakage and changes in leakage over time, which may lead to a shorter length of hospital stay. METHODS We performed a randomized controlled trial comparing the digital with analogue system, with the aim of demonstrating that use of a digital drainage system in PSP leads to a shorter hospital stay. RESULTS In 102 patients enrolled with PSP we found no differences in total duration of chest tube drainage and hospital stay between the groups. However, in a post-hoc analysis, excluding 19 patients needing surgery due to prolonged air leakage, hospital stay was significantly shorter in the digital group (median 1 days, IQR 1-5 days) compared to the analogue group (median 3 days, IQR 2-5 days) (p 0.014). Treatment failure occurred in 3 patients in both groups; the rate of recurrence within 12 weeks was not significantly different between groups (16% in the digital group versus 8% in the analogue group, p 0.339). CONCLUSION Length of hospital stay was not shorter in patients with PSP when applying a digital drainage system compared to an analogue drainage system. However, in the large subgroup of uncomplicated PSP, a significant reduction in duration of drainage and hospital stay was demonstrated with digital drainage. These findings suggest that digital drainage may be a practical alternative to manual aspiration in the management of PSP. TRIAL REGISTRATION Registered 22 September 2013 - Retrospectively registered, Trial NL4022 (NTR4195).
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Affiliation(s)
- Dieuwertje Ruigrok
- Department of Pulmonary Medicine, Spaarne Gasthuis, PO Box 417 2000, AK, Haarlem, the Netherlands
| | - Peter W A Kunst
- Department of Pulmonary Medicine, OLVG, Amsterdam, The Netherlands
| | - Marielle M J Blacha
- Department of Pulmonary Medicine, Spaarne Gasthuis, PO Box 417 2000, AK, Haarlem, the Netherlands
| | - Ben Tomlow
- Department of Pulmonary Medicine, NWZG, Alkmaar, The Netherlands
| | - Jacobine W Herbrink
- Department of Pulmonary Medicine, Spaarne Gasthuis, PO Box 417 2000, AK, Haarlem, the Netherlands
| | - Eva J Japenga
- Department of Pulmonary Medicine, OLVG, Amsterdam, The Netherlands
| | - Wim Boersma
- Department of Pulmonary Medicine, NWZG, Alkmaar, The Netherlands
| | - Paul Bresser
- Department of Pulmonary Medicine, OLVG, Amsterdam, The Netherlands
| | - Ivo van der Lee
- Department of Pulmonary Medicine, Spaarne Gasthuis, PO Box 417 2000, AK, Haarlem, the Netherlands
| | - Kris Mooren
- Department of Pulmonary Medicine, Spaarne Gasthuis, PO Box 417 2000, AK, Haarlem, the Netherlands.
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Hopkins A, Doniger SJ. Point-of-Care Ultrasound for the Pediatric Hospitalist's Practice. Hosp Pediatr 2019; 9:707-718. [PMID: 31405888 DOI: 10.1542/hpeds.2018-0118] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Point-of-care ultrasound (POCUS) has the potential to provide real-time valuable information that could alter diagnosis, treatment, and management practices in pediatric hospital medicine. We review the existing pediatric POCUS literature to identify potential clinical applications within the scope of pediatric hospital medicine. Diagnostic point-of-care applications most relevant to the pediatric hospitalist include lung ultrasound for pneumothorax, pleural effusion, pneumonia, and bronchiolitis; cardiac ultrasound for global cardiac function and hydration status; renal or bladder ultrasound for nephrolithiasis, hydronephrosis, and bladder volumes; soft tissue ultrasound for differentiating cellulitis from abscess; and procedural-guidance applications, including line placement, lumbar puncture, and abscess incision and drainage. We discuss POCUS applications with reviews of major pathologic findings, research gaps, the integration of POCUS into practice, and barriers to implementation.
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Affiliation(s)
- Akshata Hopkins
- Johns Hopkins All Children's Hospital, St. Petersburg, Florida; and
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Kepka S, Marx T, Desmettre T. Le drainage thoracique aux urgences dans la prise en charge d’un épanchement pleural non traumatique. ANNALES FRANCAISES DE MEDECINE D URGENCE 2019. [DOI: 10.3166/afmu-2019-0178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Le drainage thoracique est un geste classique en médecine d’urgence. En dehors du traumatisé thoracique, les indications de drainage thoracique aux urgences sont essentiellement le pneumothorax spontané primitif ou secondaire et les épanchements pleuraux liquidiens en cas d’épanchement parapneumonique compliqué. La technique doit être connue des médecins urgentistes qui sont confrontés à la prise en charge initiale de ces patients. Le matériel de drainage ou « drainage pleural catheter », selon la terminologie proposée par Baumann, regroupe l’ensemble des matériels de thoracocentèse laissés en place au décours du geste. Il existe une multiplicité de matériel à disposition des cliniciens qui permettent de réaliser un drainage thoracique et le choix dépend de l’indication. Les drains classiques avec mandrin sont utilisés dans le cas des épanchements liquidiens. Les drains percutanés, moins invasifs, sont préférentiellement choisis pour un épanchement gazeux. Les complications associées à ces dispositifs sont différentes selon le type du drain. Les recommandations préconisent le recours à des drains de petits calibres et vont dans le sens de méthodes de moins en moins invasives, notamment dans le cas des pneumothorax. Les modalités de transport des patients drainés sont également importantes à connaître pour la prise en charge des patients avec un drain thoracique. La possibilité d’un traitement ambulatoire en cas de pneumothorax spontanés avec un mini-drain relié à une valve de Heimlich® (Vigon, Écouen, France) ou le recours à un drain tunnélisé en cas de pleurésie récidivante constituent des options intéressantes en médecine d’urgence.
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Olesen WH, Titlestad IL, Andersen PE, Lindahl-Jacobsen R, Licht PB. Incidence of primary spontaneous pneumothorax: a validated, register-based nationwide study. ERJ Open Res 2019; 5:00022-2019. [PMID: 31205930 PMCID: PMC6556594 DOI: 10.1183/23120541.00022-2019] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 03/09/2019] [Indexed: 11/19/2022] Open
Abstract
Objectives The incidence of primary spontaneous pneumothorax is partly unknown. Commonly quoted estimates were published decades ago and recent large-scale epidemiological publications lack validation. We validated the pneumothorax diagnosis in a national registry and estimated the incidence of primary spontaneous pneumothorax in young patients. Methods Complete data on patients with an assigned pneumothorax diagnosis was retrieved from the National Danish Patient Registry. Initially, we validated the diagnosis in a selected population: all patient charts with an assigned pneumothorax diagnosis from one cardiothoracic department over a 25-year period (1984–2008) were reviewed. Subsequently, the national incidence of primary spontaneous pneumothorax in young, healthy individuals was estimated by restricting our population to patients ≤40 years of age admitted during a 5-year period (2009–2014). We performed a systematic read-though of patient charts in 50% of the complete national cohort to ensure that we only included patients with their first episode of primary spontaneous pneumothorax. Results Validation revealed a poor inter-rater agreement (κ=0.08). Therefore, we abstained from further analysis on directly retrieved data from the national database. Subsequently, a systematic re-evaluation of 7022 patients revealed an incidence rate of 12.3 cases per 100 000 (95% CI 11.5–13.1) in males and 2.2 cases per 100 000 (95% CI 1.9–2.6) in females (male/female ratio 5.9). Compared with the general Danish population, pneumothorax patients had a lower body mass index (p<0.001) and smoked more than the Danish population in general (p<0.001). Conclusions The incidence of primary spontaneous pneumothorax in a validated national study was lower than previously reported. The overall incidence of primary spontaneous pneumothorax was much lower in a validated, register-based nationwide study than previously reported. There were large sex-related differences and a confirmed, strong male predominancehttp://ow.ly/Uxjp30ob9Fz
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Affiliation(s)
| | | | | | - Rune Lindahl-Jacobsen
- Danish Aging Research Center, Unit of Epidemiology, Biostatistics and Biodemography, University of Southern Denmark, Odense, Denmark.,Max Planck Odense Center on Biodemography of Aging, Odense, Denmark
| | - Peter Bjørn Licht
- Dept of Cardiothoracic Surgery, Odense University Hospital, Odense, Denmark
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Grosu HB, Vial MR, Hernandez M, Li L, Casal RF, Eapen GA, Ost DE. Secondary spontaneous pneumothorax in cancer patients. J Thorac Dis 2019; 11:1495-1505. [PMID: 31179092 DOI: 10.21037/jtd.2019.03.35] [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] [Indexed: 11/06/2022]
Abstract
Background Malignancy-associated secondary spontaneous pneumothorax (MSSP) poses significant challenges due to limited survival. By assessing risk factors associated with a MSSP recurrence, there is potential to identify patients who could benefit from early intervention intended to prevent recurrence. Methods We performed a retrospective cohort study of patients with MSSP. The primary outcome was time to MSSP recurrence. We used a competing risk model to identify risk factors associated with MSSP recurrence. Results A total of 2,532 patients were diagnosed with pneumothorax, with 114 having MSSP but only 96 were evaluable for the time-to-recurrence analysis. Of the 96 patients, 9 (9.4%) patients experienced recurrent MSSP, and 58 (60.4%) patients died during the study's follow-up period. The estimated cumulative incidence (CI) of MSSP considering death as a competing risk was 10.1% at 15 months. The univariable model identified the following covariates as associated with MSSP recurrence: mediastinal shift (HR 12.30, 95% CI: 3.44-43.91, P<0.001), distance from lung apex to thoracic cupola (HR 1.02, 95% CI: 1.00-1.03, P=0.003), and distance between visceral and chest wall at the hilum (HR 1.02, 95% CI: 1.00-1.03, P=0.026). Conclusions Although the incidence of MSSP recurrence was found to be low, clinical factors such as sarcoma, the associated mediastinal shift, greater distance from lung apex to thoracic cupola, greater distance between visceral and chest wall at the hilum were found to be risk factors for MSSP recurrence.
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Affiliation(s)
- Horiana B Grosu
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Macarena R Vial
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Mike Hernandez
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Liang Li
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Roberto F Casal
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Georgie A Eapen
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - David E Ost
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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How spontaneous pneumothorax is managed in emergency departments: a French multicentre descriptive study. BMC Emerg Med 2019; 19:4. [PMID: 30634911 PMCID: PMC6329130 DOI: 10.1186/s12873-018-0213-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 12/10/2018] [Indexed: 11/23/2022] Open
Abstract
Background Management of spontaneous pneumothorax (SP) is still subject to debate. Although encouraging results of recent studies about outpatient management with chest drains fitted with a one-way valve, no data exist concerning application of this strategy in real life conditions. We assessed how SP are managed in Emergency departments (EDs), in particular the role of outpatient management, the types of interventions and the specialty of the physicians who perform these interventions. Methods From June 2009 to May 2013, all cases of spontaneous primary (PSP) and spontaneous secondary pneumothorax (SSP) from EDs of 14 hospitals in France were retrospectively included. First line treatment (observation, aspiration, thoracic drainage or surgery), type of management (admitted, discharged to home directly from the ED, outpatient management) and the specialty of the physicians were collected from the medical files of the ED. Results Among 1868 SP included, an outpatient management strategy was chosen in 179 PSP (10%) and 38 SSP (2%), mostly when no intervention was performed. Only 25 PSP (1%) were treated by aspiration and discharged to home after ED admission. Observation was the chosen strategy for 985 patients (53%). In 883 patients with an intervention (47%), it was performed by emergency physicians in 71% of cases and thoracic drainage was the most frequent choice (670 patients, 76%). Conclusions Our study showed the low level of implementation of outpatient management for PS in France. Despite encouraging results of studies concerning outpatient management, chest tube drainage and hospitalization remain preponderant in the treatment of SP. Electronic supplementary material The online version of this article (10.1186/s12873-018-0213-2) contains supplementary material, which is available to authorized users.
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Joharifard S, Coakley BA, Butterworth SA. Pleurectomy versus pleural abrasion for primary spontaneous pneumothorax in children. J Pediatr Surg 2017; 52:680-683. [PMID: 28168984 DOI: 10.1016/j.jpedsurg.2017.01.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2017] [Accepted: 01/23/2017] [Indexed: 10/20/2022]
Abstract
PURPOSE Primary spontaneous pneumothorax (PSP) represents a common indication for urgent surgical intervention in children. First episodes are often managed with thoracostomy tube, whereas recurrent episodes typically prompt surgery involving apical bleb resection and pleurodesis, either via pleurectomy or pleural abrasion. The purpose of this study was to assess whether pleurectomy or pleural abrasion was associated with lower postoperative recurrence. METHODS The records of patients undergoing surgery for PSP between February 2005 and December 2015 were retrospectively reviewed. Recurrence was defined as an ipsilateral pneumothorax requiring surgical intervention. Bivariate logistic regressions were used to identify factors associated with recurrence. RESULTS Fifty-two patients underwent 64 index operations for PSP (12 patients had surgery for contralateral pneumothorax, and each instance was analyzed separately). The mean age was 15.7±1.2years, and 79.7% (n=51) of patients were male. In addition to apical wedge resection, 53.1% (n=34) of patients underwent pleurectomy, 39.1% (n=25) underwent pleural abrasion, and 7.8% (n=5) had no pleural treatment. The overall recurrence rate was 23.4% (n=15). Recurrence was significantly lower in patients who underwent pleurectomy rather than pleural abrasion (8.8% vs. 40%, p<0.01). In patients who underwent pleural abrasion without pleurectomy, the relative risk of recurrence was 2.36 [1.41-3.92, p<0.01]. CONCLUSION Recurrence of PSP is significantly reduced in patients undergoing pleurectomy compared to pleural abrasion. LEVEL OF EVIDENCE Level III, retrospective comparative therapeutic study.
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Affiliation(s)
- Shahrzad Joharifard
- Division of General Surgery, Department of Surgery, University of British Columbia, Vancouver, Canada.
| | - Brian A Coakley
- Division of Pediatric Surgery, Department of Surgery, British Columbia Children's Hospital, University of British Columbia, Vancouver, Canada
| | - Sonia A Butterworth
- Division of Pediatric Surgery, Department of Surgery, British Columbia Children's Hospital, University of British Columbia, Vancouver, Canada
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Zhang D, Miao J, Hu X, Hu B, Li H. A clinical study of efficacy of polyglycolic acid sleeve after video-assisted thoracoscopic bullectomy for primary spontaneous pneumothorax. J Thorac Dis 2017; 9:1093-1099. [PMID: 28523164 DOI: 10.21037/jtd.2017.03.109] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Primary spontaneous pneumothorax (PSP) is a common disease in thoracic surgery, and a prolonged postoperative air leakage is the most frequent and troublesome early complication after video-assisted thoracoscopic (VATS) bullectomy. This study aimed to explore the efficacy of polyglycolic acid (PGA) sleeve in preventing postoperative air leakage after a VATS bullectomy for PSP. METHODS This study was a prospectively randomised clinical study. The patients who underwent a VATS bullectomy were continuously enrolled from January 2015 to June 2016 in the Beijing Chaoyang Hospital and were randomly assigned to the experimental and control groups. The experimental group applied a PGA sleeve combined with an automatic stapler in the bullectomy, while in the control group, the bullae were resected using an automatic stapler alone during the operation. In addition, the staple lines in both groups were covered with an absorbable polyglycolic acid sheet and both groups performed pleural abrasion after the resection. Useful clinical data were recorded, including the number of cases there was no air leakage immediately after the operation and air leakage lasted more than 3 days, the average postoperative air leakage, the drainage tube removal time, the postoperative hospital stay, the postoperative complications, and the postoperative recurrence. RESULTS A total of 134 patients were enrolled in this study. The experimental group consisted of 60 subjects, and there were 74 in the control group. No operative related mortality was observed in either group. In the experimental group, 44 of the 60 patients did not have an air leakage immediately after the operation, which was significantly higher than the control group (73.33% vs. 54.05%, P=0.031). Compared with the control group, the average postoperative air leakage (0.57±1.11 days), the chest tube removal time (3.03±0.92 days), and the postoperative hospital stay (3.98±0.92 days) were all significantly shorter in the experimental group (P=0.048, P=0.012, and P=0.010, respectively). Moreover, the rate of postoperative complications in the experimental group was lower than the control group (3.33% vs. 16.22%, P=0.021). No postoperative recurrence was observed in either group during the follow-up period that ranged from 8 to 25 months. CONCLUSIONS The use of PGA sleeve during surgery for PSP might effectively prevent early postoperative air leakage, as well as reduce the postoperative drainage tube removal time and the postoperative hospital stay.
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Affiliation(s)
- Duo Zhang
- Department of Thoracic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
| | - Jinbai Miao
- Department of Thoracic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
| | - Xiaoxing Hu
- Department of Thoracic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
| | - Bin Hu
- Department of Thoracic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
| | - Hui Li
- Department of Thoracic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
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Hsu HH, Chen JS. The etiology and therapy of primary spontaneous pneumothoraces. Expert Rev Respir Med 2015; 9:655-65. [DOI: 10.1586/17476348.2015.1083427] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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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: 203] [Impact Index Per Article: 22.6] [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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Rawal G, Yadav S, Garg N, Wani UR. Secondary Spontaneous Pneumothorax (SSP) with Bronchopleural Fistula in A Patient with COPD. J Clin Diagn Res 2015; 9:PD07-8. [PMID: 26023593 DOI: 10.7860/jcdr/2015/13265.5807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2015] [Accepted: 03/10/2015] [Indexed: 11/24/2022]
Abstract
The aim of this article is to report a case of secondary spontaneous pneumothorax (SSP) with bronchopleural fistula in a patient with chronic obstructive pulmonary disease (COPD). SSP is a common life threatening complication in a patient with COPD and usually creates confusion in the mind of the treating physician during an episode of acute exacerbation of COPD. A 52-year-old male presented with a three day history of dry cough and breathing difficulty. He had a history of COPD. A large pneumothorax on the left side was confirmed after chest X-ray. Tube thoracostomy was performed which showed a persistent air-leak suggesting a bronchopleural fistula. The patient was treated conservatively with patience and the leak sealed spontaneously. The patient recovered uneventfully. This case emphasizes that SSP should be considered in the differential diagnosis of patients having a history of long-term COPD who are in a relatively stable condition with non- critical respiratory distress and the importance of conducting a chest X-ray along with repeated clinical examination in a patient of COPD who does not improve with adequate therapy.
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Affiliation(s)
- Gautam Rawal
- Attending Consultant-Critical Care, Rockland Hospital , Qutab Institutional Area, New Delhi, India
| | - Sankalp Yadav
- General Duty Medical Officer-II, Chest Clinic Moti Nagar, New Delhi, India
| | - Nitin Garg
- Senior Consultant and Head-Critical Care, Rockland Hospital , Qutab Institutional Area, New Delhi, India
| | - Umar Rasool Wani
- Senior Resident-Critical Care, Rockland Hospital , Qutab Institutional Area, New Delhi, India
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Porpodis K, Zarogoulidis P, Spyratos D, Domvri K, Kioumis I, Angelis N, Konoglou M, Kolettas A, Kessisis G, Beleveslis T, Tsakiridis K, Katsikogiannis N, Kougioumtzi I, Tsiouda T, Argyriou M, Kotsakou M, Zarogoulidis K. Pneumothorax and asthma. J Thorac Dis 2014; 6 Suppl 1:S152-61. [PMID: 24672689 DOI: 10.3978/j.issn.2072-1439.2014.03.05] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2014] [Accepted: 03/04/2014] [Indexed: 01/18/2023]
Abstract
This review is focused on the relationship between asthma, pneumothorax and pneumomediastinum while presenting a number of case reports that include these conditions. The association between pneumothorax and asthma is not widely known. While asthma includes a common disorder and is prevalent worldwide, its morbidity and mortality is high when is associated with pneumothorax. Furthermore, the delayed diagnosis of pneumothorax while focusing on asthma includes the higher risk of coincidental pneumothorax in asthmatic patients. In addition, pneumomediastinum is considered benign and self-limiting condition that responds to conservative therapy. Although it is rare, the concurrence of pneumomediastinum with pneumothorax may prove fatal during a serious asthma attack. In conclusion, the symptoms of chest pain, dyspnea or focal chest findings when presented in asthmatic patients, must always create suspicion of pneumothorax or pneumomediastinum to the physician.
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Affiliation(s)
- Konstantinos Porpodis
- 1 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 2 Anaesthesiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 3 Onocology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 4 Cardiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 5 Cardiothoracic Surgery Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 6 Surgery Department (NHS), University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 7 Internal Medicine Department, "Theageneio" Cancer Hospital, Thessaloniki, Greece ; 8 2nd Cardiac Surgery Department, "Evangelismos" General Hospital, Athens, Greece ; 9 Electrophysiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece
| | - Paul Zarogoulidis
- 1 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 2 Anaesthesiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 3 Onocology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 4 Cardiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 5 Cardiothoracic Surgery Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 6 Surgery Department (NHS), University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 7 Internal Medicine Department, "Theageneio" Cancer Hospital, Thessaloniki, Greece ; 8 2nd Cardiac Surgery Department, "Evangelismos" General Hospital, Athens, Greece ; 9 Electrophysiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece
| | - Dionysios Spyratos
- 1 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 2 Anaesthesiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 3 Onocology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 4 Cardiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 5 Cardiothoracic Surgery Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 6 Surgery Department (NHS), University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 7 Internal Medicine Department, "Theageneio" Cancer Hospital, Thessaloniki, Greece ; 8 2nd Cardiac Surgery Department, "Evangelismos" General Hospital, Athens, Greece ; 9 Electrophysiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece
| | - Kalliopi Domvri
- 1 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 2 Anaesthesiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 3 Onocology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 4 Cardiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 5 Cardiothoracic Surgery Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 6 Surgery Department (NHS), University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 7 Internal Medicine Department, "Theageneio" Cancer Hospital, Thessaloniki, Greece ; 8 2nd Cardiac Surgery Department, "Evangelismos" General Hospital, Athens, Greece ; 9 Electrophysiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece
| | - Ioannis Kioumis
- 1 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 2 Anaesthesiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 3 Onocology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 4 Cardiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 5 Cardiothoracic Surgery Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 6 Surgery Department (NHS), University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 7 Internal Medicine Department, "Theageneio" Cancer Hospital, Thessaloniki, Greece ; 8 2nd Cardiac Surgery Department, "Evangelismos" General Hospital, Athens, Greece ; 9 Electrophysiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece
| | - Nikolaos Angelis
- 1 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 2 Anaesthesiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 3 Onocology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 4 Cardiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 5 Cardiothoracic Surgery Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 6 Surgery Department (NHS), University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 7 Internal Medicine Department, "Theageneio" Cancer Hospital, Thessaloniki, Greece ; 8 2nd Cardiac Surgery Department, "Evangelismos" General Hospital, Athens, Greece ; 9 Electrophysiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece
| | - Maria Konoglou
- 1 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 2 Anaesthesiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 3 Onocology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 4 Cardiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 5 Cardiothoracic Surgery Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 6 Surgery Department (NHS), University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 7 Internal Medicine Department, "Theageneio" Cancer Hospital, Thessaloniki, Greece ; 8 2nd Cardiac Surgery Department, "Evangelismos" General Hospital, Athens, Greece ; 9 Electrophysiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece
| | - Alexandros Kolettas
- 1 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 2 Anaesthesiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 3 Onocology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 4 Cardiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 5 Cardiothoracic Surgery Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 6 Surgery Department (NHS), University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 7 Internal Medicine Department, "Theageneio" Cancer Hospital, Thessaloniki, Greece ; 8 2nd Cardiac Surgery Department, "Evangelismos" General Hospital, Athens, Greece ; 9 Electrophysiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece
| | - Georgios Kessisis
- 1 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 2 Anaesthesiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 3 Onocology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 4 Cardiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 5 Cardiothoracic Surgery Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 6 Surgery Department (NHS), University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 7 Internal Medicine Department, "Theageneio" Cancer Hospital, Thessaloniki, Greece ; 8 2nd Cardiac Surgery Department, "Evangelismos" General Hospital, Athens, Greece ; 9 Electrophysiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece
| | - Thomas Beleveslis
- 1 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 2 Anaesthesiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 3 Onocology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 4 Cardiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 5 Cardiothoracic Surgery Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 6 Surgery Department (NHS), University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 7 Internal Medicine Department, "Theageneio" Cancer Hospital, Thessaloniki, Greece ; 8 2nd Cardiac Surgery Department, "Evangelismos" General Hospital, Athens, Greece ; 9 Electrophysiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece
| | - Kosmas Tsakiridis
- 1 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 2 Anaesthesiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 3 Onocology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 4 Cardiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 5 Cardiothoracic Surgery Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 6 Surgery Department (NHS), University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 7 Internal Medicine Department, "Theageneio" Cancer Hospital, Thessaloniki, Greece ; 8 2nd Cardiac Surgery Department, "Evangelismos" General Hospital, Athens, Greece ; 9 Electrophysiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece
| | - Nikolaos Katsikogiannis
- 1 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 2 Anaesthesiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 3 Onocology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 4 Cardiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 5 Cardiothoracic Surgery Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 6 Surgery Department (NHS), University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 7 Internal Medicine Department, "Theageneio" Cancer Hospital, Thessaloniki, Greece ; 8 2nd Cardiac Surgery Department, "Evangelismos" General Hospital, Athens, Greece ; 9 Electrophysiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece
| | - Ioanna Kougioumtzi
- 1 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 2 Anaesthesiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 3 Onocology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 4 Cardiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 5 Cardiothoracic Surgery Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 6 Surgery Department (NHS), University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 7 Internal Medicine Department, "Theageneio" Cancer Hospital, Thessaloniki, Greece ; 8 2nd Cardiac Surgery Department, "Evangelismos" General Hospital, Athens, Greece ; 9 Electrophysiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece
| | - Theodora Tsiouda
- 1 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 2 Anaesthesiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 3 Onocology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 4 Cardiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 5 Cardiothoracic Surgery Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 6 Surgery Department (NHS), University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 7 Internal Medicine Department, "Theageneio" Cancer Hospital, Thessaloniki, Greece ; 8 2nd Cardiac Surgery Department, "Evangelismos" General Hospital, Athens, Greece ; 9 Electrophysiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece
| | - Michael Argyriou
- 1 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 2 Anaesthesiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 3 Onocology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 4 Cardiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 5 Cardiothoracic Surgery Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 6 Surgery Department (NHS), University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 7 Internal Medicine Department, "Theageneio" Cancer Hospital, Thessaloniki, Greece ; 8 2nd Cardiac Surgery Department, "Evangelismos" General Hospital, Athens, Greece ; 9 Electrophysiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece
| | - Maria Kotsakou
- 1 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 2 Anaesthesiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 3 Onocology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 4 Cardiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 5 Cardiothoracic Surgery Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 6 Surgery Department (NHS), University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 7 Internal Medicine Department, "Theageneio" Cancer Hospital, Thessaloniki, Greece ; 8 2nd Cardiac Surgery Department, "Evangelismos" General Hospital, Athens, Greece ; 9 Electrophysiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece
| | - Konstantinos Zarogoulidis
- 1 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 2 Anaesthesiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 3 Onocology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 4 Cardiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 5 Cardiothoracic Surgery Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 6 Surgery Department (NHS), University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 7 Internal Medicine Department, "Theageneio" Cancer Hospital, Thessaloniki, Greece ; 8 2nd Cardiac Surgery Department, "Evangelismos" General Hospital, Athens, Greece ; 9 Electrophysiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece
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Abstract
Many diagnostic and therapeutic options exist for the evaluation and treatment of patients with pneumothorax. Guidelines from US and European professional societies and individual expert opinions differ in the approach to patient care. Advances in diagnostic techniques, such as real-time thoracic ultrasound, have added to the evaluation strategy. It is important for medical trainees and providers to become familiar with techniques utilized worldwide as they may be encountered in clinical practice. We review current evidence, expert recommendations, and compare professional society guidelines discussing the various diagnostic and management options for patients with pneumothorax to assist physicians and trainees involved in the care of hospitalized and outpatient adults who have primary, secondary, and traumatic iatrogenic pneumothorax. Management of traumatic non-iatrogenic pneumothorax is beyond the scope of this article, thus, not reviewed here.
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Affiliation(s)
- Matthew Trump
- Pulmonary and Critical Care Fellow, University of Missouri-Kansas City, School of Medicine, Kansas City, MO.
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Ota H, Kawai H, Matsuo T. Treatment outcomes of pneumothorax with chronic obstructive pulmonary disease. Asian Cardiovasc Thorac Ann 2013; 22:448-54. [PMID: 24771733 DOI: 10.1177/0218492313505230] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Coexisting pulmonary fibrosis and emphysema in the same individual has received increased attention. We retrospectively investigated treatment outcomes of secondary spontaneous pneumothorax in chronic obstructive pulmonary disease patients with both pulmonary fibrosis and emphysema. METHODS Among 362 consecutive secondary spontaneous pneumothorax patients treated at our hospital from 2003 to 2012, 58 with emphysema-dominant chronic obstructive pulmonary disease (all elderly men with a smoking history) were enrolled and divided into 2 groups based on computed tomography images: emphysema alone (n = 51) and coexisting emphysema and pulmonary fibrosis (n = 7). The clinical characteristics and mortality were compared between the 2 groups. RESULTS There was no significant difference in the recurrence rate after nonsurgical treatment. No patient died of pneumothorax-related complications, but one of 2 with pulmonary fibrosis who underwent surgery died of a postoperative respiratory complication. The mortality rate from respiratory failure during follow-up was significantly higher in the group with pulmonary fibrosis (6/7) than in the group without pulmonary fibrosis (11/51, p = 0.002). The median survival was 0.8 years in the group with pulmonary fibrosis vs. and 5.4 years in the group without pulmonary fibrosis. CONCLUSIONS The coexistence of pulmonary fibrosis and emphysema on computed tomography images may represent a predictor of respiratory mortality in elderly chronic obstructive pulmonary disease patients with secondary spontaneous pneumothorax. Because of the potential risk of respiratory failure, we recommend nonsurgical treatment for secondary spontaneous pneumothorax in chronic obstructive pulmonary disease patients with these radiological features.
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Affiliation(s)
- Hideki Ota
- Department of Thoracic Surgery, Akita Red Cross Hospital, Akita, Japan
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El Hammoumi MM, Drissi G, Achir A, Benchekroun A, Benosman A, Kabiri EH. Iatrogenic pneumothorax: experience of a Moroccan Emergency Center. REVISTA PORTUGUESA DE PNEUMOLOGIA 2012. [PMID: 23200118 DOI: 10.1016/j.rppneu.2012.09.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The incidence of iatrogenic pneumothorax (IPx) will increase with invasive procedures particularly at training hospitals, that is why we have made a retrospective study of the common diagnostic or therapeutic causes of IPx and its impact on morbidity. From January 2011 to December 2011, 36 patients developed IPx as emergencies, after an invasive procedure. Their mean age was 38 years (range: 19-69 years). Of the patients, 21 (58%) were male and 15 (42%) were female. The purpose was diagnostic in 6 cases and therapeutic in 30 cases. In 8 patients (22%) the procedure was performed due to underlying lung diseases and in 28 patients (78%) for other diseases. The procedure most frequently causing IPnx was central venous catheterization, with 20 patients (55%), other frequent causes were mechanical ventilation in 8 cases (22%) (of whom we reported 3 cases of bilateral pneumothorax), 6 cases of thoracentesis (16%) and 2 patients had life-saving percutaneous tracheotomy. The majority of our patients were managed by a small chest tube placement (unilateral n=30, bilateral n=3). The average duration of drainage was 3 days (range: 1-15 days), sadly one of our patients died of ischemic brain damage 15 days after tracheotomy. At training hospitals the incidence of IPnx will increase with the increase in invasive procedures, which should only be performed by experienced personnel or under their supervision.
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Affiliation(s)
- M M El Hammoumi
- Department of Thoracic Surgery Mohammed V Military Teaching Hospital, Faculté de médecine et de pharmacie Université Mohamed V Souissi, Rabat, Morocco.
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Desmettre T, Meurice JC, Tapponnier R, Pretalli JB, Dalphin JC. [The EXPRED study: where are we?]. Rev Mal Respir 2012; 30:18-21. [PMID: 23318185 DOI: 10.1016/j.rmr.2012.09.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2012] [Accepted: 09/25/2012] [Indexed: 10/27/2022]
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Abstract
Spontaneous pneumothorax (SP) occurs when air enters the pleural space in the absence of a traumatic or iatrogenic etiology and is an uncommon phenomenon in the pediatric population. Although the typical presentation has been well described in the literature, much debate still surrounds the epidemiology, pathophysiology, diagnosis, and management of this condition in the pediatric population. To date, much of the emphasis in the pediatric literature has been on surgical options. Questions still remain regarding the true incidence of this disease in children, appropriate diagnostic imaging, and treatment recommendations for practitioners in the emergency department setting. This review of the evidence seeks to elaborate on current knowledge and clinical practice, as well as the applicability of adult recommendations to the pediatric population.
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GALBOIS A, ZORZI L, MEURISSE S, KERNÉIS S, MARGETIS D, ALVES M, AIT-OUFELLA H, BAUDEL JL, OFFENSTADT G, MAURY E, GUIDET B. Outcome of spontaneous and iatrogenic pneumothoraces managed with small-bore chest tubes. Acta Anaesthesiol Scand 2012; 56:507-12. [PMID: 22191997 DOI: 10.1111/j.1399-6576.2011.02602.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2011] [Indexed: 11/28/2022]
Abstract
BACKGROUND Little is known about the efficacy of management of iatrogenic pneumothoraces with small-bore chest tubes. The aim of this study was to assess the outcome of iatrogenic pneumothoraces requiring drainage managed with a small-bore chest tube and to compare the results to spontaneous pneumothoraces treated in the same unit with the same device. The primary outcome was requirement of video-assisted thoracoscopic surgery for drainage failure; secondary outcomes were length of drainage and number of inserted chest tubes. METHODS Patients with pneumothorax admitted between 1997 and 2007 were retrospectively identified. Traumatic pneumothoraces and those occurring under mechanical ventilation were excluded. All pneumothoraces were drained using the same small-bore chest tube (8 French) according to our local protocol. RESULTS Five hundred sixty-one pneumothoraces were analysed, 431 (76.8%) were spontaneous pneumothoraces and 130 (23.2%) were iatrogenic. Iatrogenic pneumothoraces were associated with less requirement of video-assisted thoracoscopic surgery for drainage failure [adjusted odds ratio= 0.24 (0.04, 0.86)]. Length of drainage of iatrogenic pneumothoraces was longer than for primary spontaneous pneumothoraces (3.8 ± 3.1 vs. 2.7 ± 1.8 days, P < 0.001) and shorter than for secondary spontaneous pneumothoraces (4.6 ± 2.3 days, P = 0.004). Number of inserted chest tubes per patient was not significantly different according to pneumothoraces' aetiology. CONCLUSION Small-bore chest tubes are feasible for treatment of iatrogenic pneumothoraces and have a better rate of success and slightly longer drainage duration than when used for spontaneous pneumothoraces.
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Affiliation(s)
| | - L. ZORZI
- AP-HP; Hôpital Saint-Antoine, Service de Réanimation Médicale; Paris; France
| | | | | | | | | | | | - J.-L. BAUDEL
- AP-HP; Hôpital Saint-Antoine, Service de Réanimation Médicale; Paris; France
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Desmettre T, Meurice JC, Mauny F, Woronoff MC, Tiffet O, Schmidt J, Ferretti G, Dalphin JC. [Comparison of simple aspiration versus standard drainage in the treatment of large primary spontaneous pneumothorax]. Rev Mal Respir 2011; 28:336-43. [PMID: 21482337 DOI: 10.1016/j.rmr.2010.10.030] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2010] [Accepted: 10/26/2010] [Indexed: 11/28/2022]
Abstract
BACKGROUND Chest tube drainage is the standard treatment of a large spontaneous pneumothorax. Aspiration is an alternative technique that is simple and rapid to learn, and the success rate seems identical to chest tube drainage. Its widespread use justifies studies to define its place in the management strategy of spontaneous pneumothorax. METHODS We propose a multicentre, prospective, randomized, open trial with two parallel groups. The main objective is to compare the therapeutic efficacy of a simple aspiration with chest tube drainage for a first large spontaneous pneumothorax. The hypothesis is that aspiration is not inferior to a chest drain in its immediate effect. The secondary objectives are to compare the therapeutic efficacy at 24h and at one-week, the relapse rate at one year, and the tolerance and complications. A comparison of both the medical and economic aspects will be made. With an α-risk of 0.05 and a β-risk of 0.10, a proportion of failures of 30% expected in both groups and a target of non-inferiority of δ=0.15, the number of subjects to be included is 200 per group, totalling 400 in all. EXPECTED RESULTS In the case of equivalence, this study should help to better define the place of aspiration compared to chest tube drainage in the management of spontaneous pneumothorax.
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Affiliation(s)
- T Desmettre
- Pôle urgences/réanimation médicale/samu, service d'accueil des urgences/samu 25, hôpital Jean-Minjoz, CHU de Besançon, boulevard Fleming, Besançon cedex, France.
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25
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Abstract
Pneumothorax is a pathological condition in which air accumulates within the thoracic cavity. Pneumothorax affects animals without sex or age predilections; however, it has been suggested that the Siberian husky breed of dog has a predisposition for spontaneous pneumothorax. Pneumothorax occurs as the result of trauma or underlying disease and can present a clinical challenge with regard to diagnostic and therapeutic techniques. Topics reviewed include normal lung physiology; the pathogenesis, diagnosis, treatment, complications, and prognosis of pneumothorax; and current techniques in animals and humans.
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Affiliation(s)
- Danielle R. Pawloski
- Department of Clinical Sciences, Center for Veterinary Health Sciences, Oklahoma State University, Stillwater, Oklahoma 74078
- From the
| | - Kristyn D. Broaddus
- Department of Clinical Sciences, Center for Veterinary Health Sciences, Oklahoma State University, Stillwater, Oklahoma 74078
- From the
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26
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Gygax-Genero M, Manen O, Chemsi M, Bisconte S, Dubourdieu D, Vacher A, Brocq FX, Leduc PA, Deroche J, Boussif M, Perrier E, Gourbat JP. [Treatment specifics for spontaneous pneumothorax in flight personnel]. REVUE DE PNEUMOLOGIE CLINIQUE 2010; 66:302-307. [PMID: 21087725 DOI: 10.1016/j.pneumo.2010.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2010] [Accepted: 06/24/2010] [Indexed: 05/30/2023]
Abstract
Spontaneous pneumothorax is one cause of aeronautical unfitness in flight personnel, because of the risk of recurrence in flight, making it an issue of flight safety. Specific treatment is required for fighter pilots, pilots flying single-pilot and pilots in professional training: surgical synthesis via video-thoracoscopy is obligatory from the first episode. Considering the exposure to an accumulation of aeronautical factors that are likely to encourage pneumothorax recurrence in flight, it is apical pleurectomy together with abrasion of the remaining pleura and resection of bullae/blebs that is required for fighter pilots to allow them to recover aeronautical fitness unrestrictedly. For all other categories of flight personnel, treatment is no different from that of the common patient. Knowledge of these treatment specifics is essential, to avoid unnecessary systematic surgical indication for all flight personnel, or jeopardise professional fitness in some of them due to inappropriate treatment.
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Affiliation(s)
- M Gygax-Genero
- Centre principal d'expertise médicale du personnel navigant, hôpital d'instruction des armées Percy, Ilôt Percy, Clamart, France.
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Hagaman JT, Schauer DP, McCormack FX, Kinder BW. Screening for lymphangioleiomyomatosis by high-resolution computed tomography in young, nonsmoking women presenting with spontaneous pneumothorax is cost-effective. Am J Respir Crit Care Med 2010; 181:1376-82. [PMID: 20167846 DOI: 10.1164/rccm.200910-1553oc] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Women with pulmonary lymphangioleiomyomatosis (LAM) who present with a sentinel spontaneous pneumothorax (SPTX) will experience an average of 2.5 additional pneumothoraces. The diagnosis of LAM is typically delayed until after the second pneumothorax. OBJECTIVES We hypothesized that targeted screening of an LAM-enriched population of nonsmoking women between the ages of 25 and 54 years, who present with a sentinel pneumothorax indicated by high-resolution computed tomography (HRCT), will facilitate early identification, definitive therapy, and improved quality of life for patients with LAM. METHODS We constructed a Markov state-transition model to assess the cost-effectiveness of screening. Rates of SPTX and prevalence of LAM in populations stratified by age, sex, and smoking status were derived from the literature. Costs of testing and treatment were extracted from 2007 Medicare data. We compared a strategy based on HRCT screening followed by pleurodesis for patients with LAM, versus no HRCT screening. MEASUREMENTS AND MAIN RESULTS The prevalence of LAM in nonsmoking women, between the ages of 25 and 54 years, with SPTX is estimated at 5% on the basis of the available literature. In our base case analysis, screening for LAM by HRCT is the most cost-effective strategy, with a marginal cost-effectiveness ratio of $32,980 per quality-adjusted life-year gained. Sensitivity analysis showed that HRCT screening remains cost-effective for groups in which the prevalence of LAM in the population subset screened is greater than 2.5%. CONCLUSIONS Screening for LAM by HRCT in nonsmoking women age 25-54 that present with SPTX is cost-effective. Physicians are advised to screen for LAM by HRCT in this population.
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Affiliation(s)
- Jared T Hagaman
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Cincinnati, 231 Albert Sabin Way, Cincinnati, OH 45267, 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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Rivas de Andrés JJ, Jiménez López MF, Molins López-Rodó L, Pérez Trullén A, Torres Lanzas J. [Guidelines for the diagnosis and treatment of spontaneous pneumothorax]. Arch Bronconeumol 2009; 44:437-48. [PMID: 18775256 DOI: 10.1016/s1579-2129(08)60077-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This is the fourth update of the guidelines for the diagnosis and treatment of pneumothorax published by the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR). Spontaneous pneumothorax, or the presence of air in the pleural space not caused by injury or medical intervention, is a significant clinical problem. We propose a method for classifying cases into 3 categories: partial, complete, and complete with total lung collapse. This classification, together with a clinical assessment, would provide sufficient information to enable physicians to decide on an approach to treatment. This update introduces simple aspiration in an outpatient setting as a treatment option that has yielded results comparable to conventional drainage in the management of uncomplicated primary spontaneous pneumothorax; this technique is not, as yet, widely used in Spain. For the definitive treatment of primary spontaneous pneumothorax, the technique most often used by thoracic surgeons is video-assisted thoracoscopic bullectomy and pleural abrasion. Hospitalization and conventional tube drainage is recommended for the treatment of secondary spontaneous pneumothorax. This update also has a new section on catamenial pneumothorax, a condition that is probably underdiagnosed. The definitive treatment for a recurring or persistent air leak is usually surgery or the application of talc through the drainage tube when surgery is contraindicated. Our aim in proposing algorithms for the management of pneumothorax in these guidelines was to provide a useful tool for clinicians involved in the diagnosis and treatment of this disease.
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Affiliation(s)
- Juan J Rivas de Andrés
- Servicio de Cirugía Torácica de Aragón, Hospital Universitario Miguel Servet, Zaragoza, España.
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Rivas de Andrés JJ, Jiménez López MF, López-Rodó LM, Pérez Trullén A, Torres Lanzas J. Normativa sobre el diagnóstico y tratamiento del neumotórax espontáneo. Arch Bronconeumol 2008. [DOI: 10.1016/s0300-2896(08)72108-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Sakurai H. Videothoracoscopic surgical approach for spontaneous pneumothorax: review of the pertinent literature. World J Emerg Surg 2008; 3:23. [PMID: 18644115 PMCID: PMC2494544 DOI: 10.1186/1749-7922-3-23] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2008] [Accepted: 07/21/2008] [Indexed: 11/24/2022] Open
Abstract
Spontaneous pneumothorax is usually caused by the rupture of subpleural blebs/bullae in the underlying lung and is one of the most common elective applications of video-assisted thoracoscopic surgery (VATS). VATS has been used as an alternative to thoracotomy in the treatment of spontaneous pneumothorax. Recurrent pneumothorax and persistent air leakage are quite often indications for spontaneous pneumothorax, and bilateral spontaneous pneumothorax is also considered to be an indication for surgical intervention. The goals of surgical intervention are to eliminate intrapleural air collection and prevent recurrence. Diverse procedures have been reported in the surgical treatment for spontaneous pneumothorax. We review the literature regarding the VATS approach for spontaneous pneumothorax.
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Affiliation(s)
- Hiroyuki Sakurai
- Department of Thoracic Surgery, Saiseikai Central Hospital, Tokyo, Japan.
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32
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Cheng YL. Both Spontaneous Pneumothorax and Spontaneous Pneumomediastinum May Constitute a Complication in Underweight Patients: Response. Chest 2008. [DOI: 10.1378/chest.08-0664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Chan SSW. The Role of Simple Aspiration in the Management of Primary Spontaneous Pneumothorax. J Emerg Med 2008; 34:131-8. [DOI: 10.1016/j.jemermed.2007.05.040] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2006] [Revised: 12/01/2006] [Accepted: 02/11/2007] [Indexed: 11/29/2022]
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Abstract
Dyspnea is among the most frequent complaints in the elderly. The prevalence of comorbid medical conditions and the physiologic changes of aging present significant challenges in determining the cause. The initial approach to the elderly dyspneic patient mandates consideration of a broad range of diagnoses. Failure to diagnose life-threatening medical conditions presenting with dyspnea such as pulmonary embolus, acute coronary syndromes, congestive heart failure, asthma, obstructive pulmonary disease, pneumothorax, and pneumonia can lead significant morbidity and mortality. This article focuses on the rapid assessment and approach to the acutely dyspneic elderly patient.
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Affiliation(s)
- Mercedes Torres
- Department of Emergency Medicine, University of Maryland School of Medicine, 110 South Paca Street, Sixth Floor, Suite 200, Baltimore, MD 21201, USA
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Choi WJ, Park YS, Jeong SM, Ku SW, Park PH. Bilateral Pneumothorax Induced by Tracheal Injury during Total Thyroidectomy with Modified Radical Neck Dissection - A case report -. Korean J Anesthesiol 2007. [DOI: 10.4097/kjae.2007.53.3.399] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Woo Jong Choi
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, Ulsan University School of Medicine, Seoul, Korea
| | - Young Soo Park
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, Ulsan University School of Medicine, Seoul, Korea
| | - Sung Moon Jeong
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, Ulsan University School of Medicine, Seoul, Korea
| | - Seung Woo Ku
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, Ulsan University School of Medicine, Seoul, Korea
| | - Pyong Hwan Park
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, Ulsan University School of Medicine, Seoul, Korea
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