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Cheng J, Ma A, Liang G. Simple aspiration for spontaneous pneumothorax in adults: A systematic review and meta-analysis of randomized controlled trials. Am J Emerg Med 2024; 80:99-106. [PMID: 38537340 DOI: 10.1016/j.ajem.2024.03.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 03/04/2024] [Accepted: 03/15/2024] [Indexed: 05/31/2024] Open
Abstract
BACKGROUND Spontaneous pneumothorax (SP) is a widespread clinical entity, and methods of managing adult SP remain controversial. The aim of this meta-analysis was to further determine the clinical efficacy and safety of simple aspiration (SA) in comparison to intercostal tube drainage (ITD) during the management of adult SP. METHODS EMBASE, Medline and the Cochrane Central Register of Controlled Trials via Ovid SP were searched (to June 2023) to identify randomized controlled trials (RCT) that reported outcomes of interest after comparing SA with ITD for the management of adult SP. RESULTS The search strategy yielded 1447 citations, of which 10 RCTs enrolling 1044 subjects were included. Compared with the ITD group, the SA group had a significantly lower the initial success rate of the procedure for the management of SP (OR 0.63, 95% CI [0.47-0.86]; P = 0.004). Moreover, SA was associated with a decreased duration of hospitalization (mean difference-2.05 days, 95% CI [-2.66 - -1.44]; P < 0.001) and a decreased need for operation (P = 0.03). For frequently reported adverse events such as subcutaneous emphysema (P = 0.32), bleeding (P = 0.0.26) and wound infection (P = 0.07), no significant difference between the SA and ITD groups was found. There was no significant difference for other outcomes. Subgroup analysis found that there was no significant difference between SA and ITD in terms of the initial success rate, 1-week success rate or any type of adverse event for PSP patients. CONCLUSIONS In the management of adult SP, the use of SA decreased the initial success rate but also decreased the duration of hospitalization and the need for operation compared with ITD. The incidence of adverse events did not differ between the two approaches. The research plan was registered at PROSPERO, and the registration number was CRD42023436770.
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Affiliation(s)
- Jiangli Cheng
- Department of Respiratory Care, West China Hospital of Sichuan University, Guoxue Alley 37#, Wuhou District, Chengdu, Sichuan 610041, China
| | - Aijia Ma
- Department of Critical Care Medicine, West China Hospital of Sichuan University, Guoxue Alley 37#, Wuhou District, Chengdu, Sichuan 610041, China
| | - Guopeng Liang
- Department of Respiratory Care, West China Hospital of Sichuan University, Guoxue Alley 37#, Wuhou District, Chengdu, Sichuan 610041, China.
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2
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Walker S, Hallifax R, Ricciardi S, Fitzgerald D, Keijzers M, Lauk O, Petersen J, Bertolaccini L, Bodtger U, Clive A, Elia S, Froudarakis M, Janssen J, Lee YCG, Licht P, Massard G, Nagavci B, Neudecker J, Roessner E, Van Schil P, Waller D, Walles T, Cardillo G, Maskell N, Rahman N. Joint ERS/EACTS/ESTS clinical practice guidelines on adults with spontaneous pneumothorax. Eur J Cardiothorac Surg 2024; 65:ezae189. [PMID: 38804185 DOI: 10.1093/ejcts/ezae189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 02/09/2024] [Indexed: 05/29/2024] Open
Abstract
OBJECTIVES The optimal management for spontaneous pneumothorax (SP) remains contentious, with various proposed approaches. This joint clinical practice guideline from the ERS, EACTS and ESTS societies provides evidence-based recommendations for the management of SP. METHODS This multidisciplinary Task Force addressed 12 key clinical questions on the management of pneumothorax, using ERS methodology for guideline development. Systematic searches were performed in MEDLINE and Embase. Evidence was synthesised by conducting meta-analyses, if possible, or narratively. Certainty of evidence was rated with GRADE (Grading, Recommendation, Assessment, Development and Evaluation). The Evidence to Decision framework was used to decide on the direction and strength of the recommendations. RESULTS The panel makes a conditional recommendation for conservative care of minimally symptomatic patients with primary spontaneous pneumothorax (PSP) who are clinically stable. We make a strong recommendation for needle aspiration over chest tube drain for initial PSP treatment. We make a conditional recommendation for ambulatory management for initial PSP treatment. We make a conditional recommendation for early surgical intervention for the initial treatment of PSP in patients who prioritise recurrence prevention. The panel makes a conditional recommendation for autologous blood patch in secondary SP patients with persistent air leak (PAL). The panel could not make recommendations for other interventions, including bronchial valves, suction, pleurodesis in addition to surgical resection or type of surgical pleurodesis. CONCLUSIONS With this international guideline, the ERS, EACTS and ESTS societies provide clinical practice recommendations for SP management. We highlight evidence gaps for the management of PAL and recurrence prevention, with research recommendations made. SHAREABLE ABSTRACT This update of an ERS Task Force statement from 2015 provides a concise comprehensive update of the literature base. 24 evidence-based recommendations were made for management of pneumothorax, balancing clinical priorities and patient views.https://bit.ly/3TKGp9e.
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Affiliation(s)
- Steven Walker
- Academic Respiratory Unit, Southmead Hospital, Bristol, UK
- Junior Chair of the Task Force
| | - Robert Hallifax
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Trust, Oxford, UK
- Oxford Respiratory Trials Unit, University of Oxford, Oxford, UK
| | - Sara Ricciardi
- Unit of Thoracic Surgery, Azienda Ospedaliera San Camillo Forlanini, Rome, Italy
- Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Deirdre Fitzgerald
- Pleural Medicine Unit, Institute for Respiratory Health, Perth, Australia
- Medical School and Centre for Respiratory Health, University of Western Australia, Perth, Australia
| | - Marlies Keijzers
- Department of Surgery, Maxima Medical Center, Veldhoven, Netherlands
| | - Olivia Lauk
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Jesper Petersen
- Respiratory Research Unit PLUZ, Department of Respiratory Medicine Zealand, University Hospital, Naestved, Denmark
| | - Luca Bertolaccini
- Division of Thoracic Surgery IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Uffe Bodtger
- Respiratory Research Unit PLUZ, Department of Respiratory Medicine Zealand, University Hospital, Naestved, Denmark
| | - Amelia Clive
- North Bristol Lung Centre, Southmead Hospital, Bristol, UK
| | - Stefano Elia
- Department of Medicine and Health Sciences "V. Tiberio", University of Molise, Campobasso, Italy
- Thoracic Surgical Oncology Programme, Tor Vergata University Hospital, Rome, Italy
| | - Marios Froudarakis
- Medical School, Democritus University of Thrace, Alexandroupolis, Greece
- Medical School, University Jean Monnet, Saint Etienne, France
| | - Julius Janssen
- Department of Pulmonology, Canisius Wilhelmina Hospital, Nijmegen, Netherlands
| | - Y C Gary Lee
- Pleural Medicine Unit, Institute for Respiratory Health, Perth, Australia
- Medical School and Centre for Respiratory Health, University of Western Australia, Perth, Australia
| | - Peter Licht
- Department of Cardiothoracic Surgery, Odense University Hospital, Odense, Denmark
| | - Gilbert Massard
- Department of Thoracic Surgery, University of Luxembourg, Hôpitaux Robert Schuman, Luxembourg, Luxembourg
| | - Blin Nagavci
- Institute for Evidence in Medicine, University Medical Center Freiburg, Freiburg, Germany
| | - Jens Neudecker
- Competence Center for Thoracic Surgery, Charité - Universitätsmedizin, Berlin, Germany
- Department of Surgery, Campus Charité Mitte, Campus Virchow-Klinikum, Berlin, Germany
| | - Eric Roessner
- Department of Thoracic Surgery, Center for Thoracic Diseases, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Paul Van Schil
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Edegem, Belgium
| | - David Waller
- Thorax Centre, St Bartholomew's Hospital, London, UK
| | - Thorsten Walles
- Clinic for Cardiac and Thoracic Surgery, Magdeburg University Hospital, Magdeburg, Germany
| | - Giuseppe Cardillo
- Unit of Thoracic Surgery, Azienda Ospedaliera San Camillo Forlanini, Rome, Italy
- Alma Mater Studiorum, University of Bologna, Bologna, Italy
- Unicamillus-International University of Health Sciences, Rome, Italy
- Senior Chairs of the Task Force
| | - Nick Maskell
- Academic Respiratory Unit, Southmead Hospital, Bristol, UK
- North Bristol Lung Centre, Southmead Hospital, Bristol, UK
- Senior Chairs of the Task Force
| | - Najib Rahman
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Trust, Oxford, UK
- Oxford Respiratory Trials Unit, University of Oxford, Oxford, UK
- Oxford NIHR Biomedical Research Centre, Oxford, UK
- Chinese Academy of Medical Sciences Oxford Institute, Oxford, UK
- Senior Chairs of the Task Force
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3
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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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4
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Walker S, Hallifax R, Ricciardi S, Fitzgerald D, Keijzers M, Lauk O, Petersen J, Bertolaccini L, Bodtger U, Clive A, Elia S, Froudarakis M, Janssen J, Lee YCG, Licht P, Massard G, Nagavci B, Neudecker J, Roessner E, Van Schil P, Waller D, Walles T, Cardillo G, Maskell N, Rahman N. Joint ERS/EACTS/ESTS clinical practice guidelines on adults with spontaneous pneumothorax. Eur Respir J 2024; 63:2300797. [PMID: 38806203 DOI: 10.1183/13993003.00797-2023] [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: 05/31/2023] [Accepted: 02/09/2024] [Indexed: 05/30/2024]
Abstract
BACKGROUND The optimal management for spontaneous pneumothorax (SP) remains contentious, with various proposed approaches. This joint clinical practice guideline from the ERS, EACTS and ESTS societies provides evidence-based recommendations for the management of SP. METHODS This multidisciplinary Task Force addressed 12 key clinical questions on the management of pneumothorax, using ERS methodology for guideline development. Systematic searches were performed in MEDLINE and Embase. Evidence was synthesised by conducting meta-analyses, if possible, or narratively. Certainty of evidence was rated with GRADE (Grading of Recommendations, Assessment, Development and Evaluations). The Evidence to Decision framework was used to decide on the direction and strength of the recommendations. RESULTS The panel makes a conditional recommendation for conservative care of minimally symptomatic patients with primary spontaneous pneumothorax (PSP) who are clinically stable. We make a strong recommendation for needle aspiration over chest tube drain for initial PSP treatment. We make a conditional recommendation for ambulatory management for initial PSP treatment. We make a conditional recommendation for early surgical intervention for the initial treatment of PSP in patients who prioritise recurrence prevention. The panel makes a conditional recommendation for autologous blood patch in secondary SP patients with persistent air leak (PAL). The panel could not make recommendations for other interventions, including bronchial valves, suction, pleurodesis in addition to surgical resection or type of surgical pleurodesis. CONCLUSIONS With this international guideline, the ERS, EACTS and ESTS societies provide clinical practice recommendations for SP management. We highlight evidence gaps for the management of PAL and recurrence prevention, with research recommendations made.
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Affiliation(s)
- Steven Walker
- Academic Respiratory Unit, Southmead Hospital, Bristol, UK
- Junior Chair of the Task Force
| | - Robert Hallifax
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Trust, Oxford, UK
- Oxford Respiratory Trials Unit, University of Oxford, Oxford, UK
| | - Sara Ricciardi
- Unit of Thoracic Surgery, Azienda Ospedaliera San Camillo Forlanini, Rome, Italy
- Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Deirdre Fitzgerald
- Pleural Medicine Unit, Institute for Respiratory Health, Perth, Australia
- Medical School and Centre for Respiratory Health, University of Western Australia, Perth, Australia
| | - Marlies Keijzers
- Department of Surgery, Maxima Medical Center, Veldhoven, The Netherlands
| | - Olivia Lauk
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Jesper Petersen
- Respiratory Research Unit PLUZ, Department of Respiratory Medicine Zealand, University Hospital, Naestved, Denmark
| | - Luca Bertolaccini
- Division of Thoracic Surgery IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Uffe Bodtger
- Respiratory Research Unit PLUZ, Department of Respiratory Medicine Zealand, University Hospital, Naestved, Denmark
| | - Amelia Clive
- North Bristol Lung Centre, Southmead Hospital, Bristol, UK
| | - Stefano Elia
- Department of Medicine and Health Sciences "V. Tiberio", University of Molise, Campobasso, Italy
- Thoracic Surgical Oncology Programme, Tor Vergata University Hospital, Rome, Italy
| | - Marios Froudarakis
- Medical School, Democritus University of Thrace, Alexandroupolis, Greece
- Medical School, University Jean Monnet, Saint Etienne, France
| | - Julius Janssen
- Department of Pulmonology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Y C Gary Lee
- Pleural Medicine Unit, Institute for Respiratory Health, Perth, Australia
- Medical School and Centre for Respiratory Health, University of Western Australia, Perth, Australia
| | - Peter Licht
- Department of Cardiothoracic Surgery, Odense University Hospital, Odense, Denmark
| | - Gilbert Massard
- Department of Thoracic Surgery, University of Luxembourg, Hôpitaux Robert Schuman, Luxembourg, Luxembourg
| | - Blin Nagavci
- Institute for Evidence in Medicine, University Medical Center Freiburg, Freiburg, Germany
| | - Jens Neudecker
- Competence Center for Thoracic Surgery, Charité - Universitätsmedizin, Berlin, Germany
- Department of Surgery, Campus Charité Mitte, Campus Virchow-Klinikum, Berlin, Germany
| | - Eric Roessner
- Department of Thoracic Surgery, Center for Thoracic Diseases, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Paul Van Schil
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Edegem, Belgium
| | - David Waller
- Thorax Centre, St Bartholomew's Hospital, London, UK
| | - Thorsten Walles
- Clinic for Cardiac and Thoracic Surgery, Magdeburg University Hospital, Magdeburg, Germany
| | - Giuseppe Cardillo
- Unit of Thoracic Surgery, Azienda Ospedaliera San Camillo Forlanini, Rome, Italy
- Alma Mater Studiorum, University of Bologna, Bologna, Italy
- Unicamillus - International University of Health Sciences, Rome, Italy
- Senior Chairs of the Task Force
| | - Nick Maskell
- Academic Respiratory Unit, Southmead Hospital, Bristol, UK
- North Bristol Lung Centre, Southmead Hospital, Bristol, UK
- Senior Chairs of the Task Force
| | - Najib Rahman
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Trust, Oxford, UK
- Oxford Respiratory Trials Unit, University of Oxford, Oxford, UK
- Oxford NIHR Biomedical Research Centre, Oxford, UK
- Chinese Academy of Medical Sciences Oxford Institute, Oxford, UK
- Senior Chairs of the Task Force
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Shorthose M, Barton E, Walker S. The contemporary management of spontaneous pneumothorax in adults. Breathe (Sheff) 2023; 19:230135. [PMID: 38229681 PMCID: PMC10790175 DOI: 10.1183/20734735.0135-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 10/12/2023] [Indexed: 01/18/2024] Open
Abstract
Spontaneous pneumothorax is a common presentation, and there has been a recent surge of research into the condition. With the recent publication of the new British Thoracic Society guidelines and the upcoming European Respiratory Society guidelines, we provide a concise up-to-date summary of clinical learning points. In particular we focus on the role of conservative or ambulatory management, as well as treatment options for persistent air leak and guidance for when to refer to thoracic surgeons for the prevention of the recurrence of pneumothorax. Educational aims To give up-to-date guidance on the acute management of spontaneous pneumothorax, including the role of conservative or ambulatory managementTo discuss the different treatment options for persistent air leak.To guide physicians on when to refer patients to thoracic surgeons for the prevention of the recurrence of pneumothorax.
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Affiliation(s)
| | - Eleanor Barton
- Academic Respiratory Unit, North Bristol NHS Trust, Bristol, UK
| | - Steven Walker
- Academic Respiratory Unit, North Bristol NHS Trust, Bristol, UK
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Eamer G, Povolo CA, Petropoulos JA, Ohinmaa A, Vanhouwelingen L. Observation, Aspiration, or Tube Thoracostomy for Primary Spontaneous Pneumothorax: A Systematic Review, Meta-Analysis, and Cost-Utility Analysis. Chest 2023; 164:1007-1018. [PMID: 37209773 DOI: 10.1016/j.chest.2023.05.017] [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: 10/31/2022] [Revised: 04/30/2023] [Accepted: 05/01/2023] [Indexed: 05/22/2023] Open
Abstract
BACKGROUND Primary spontaneous pneumothorax (PSP) has several commonly used management strategies: observation, aspiration, and chest tube placement. Economic modelling of pooled data comparing techniques has not been performed. RESEARCH QUESTION Based on studies from the past 20 years, which approach to management of PSP delivers the highest utility? STUDY DESIGN AND METHODS A systematic review of PSP management strategies (observation, aspiration, or chest tube placement) included in the Medline and EMBASE databases from January 1, 2000, through April 10, 2020, was conducted. Text screening, bias assessment, and data extraction were performed by two authors (G. E. and C. A. P.). Inclusion and exclusion criteria were defined a priori. The primary outcome was PSP resolution after the initial intervention. Secondary outcomes were PSP recurrence, length of stay, rate of surgical management, and complications. The meta-analysis compared treatment arms; dichotomous outcomes were reported as relative risk (RRs) and continuous outcomes were reported as mean differences. A cost-utility analysis within the Canadian health care system context with deterministic and probabilistic sensitivity analyses was performed. RESULTS Five thousand one hundred seventy-nine articles were identified; after screening, 22 articles were included. Most trials showed a high risk of bias, but randomized trials showed a lower risk. Compared with chest tube placement, observation (mean difference, 5.17; 95% CI, 3.75-6.59; P < .01; I2 = 62%) and aspiration (mean difference, 2.72; 95% CI, 2.39-3.04; P < .01; I2 = 0%) showed a shorter length of stay. Compared with observation, chest tube placement (RR, 0.81; 95% CI, 0.71-0.91; P < .01; I2 = 62%) and aspiration (RR, 0.73; 95% CI, 0.61-0.88; P < .01; I2 = 67%) showed higher resolution without additional intervention. Two-year recurrence rates did not differ between management strategies. Observation showed the best utility (0.82) and lowest cost; observation was the optimal strategy in 98.2% of Monte Carlo simulations. INTERPRETATION Observation is the dominant choice compared with aspiration and chest tube placement for PSP. It should be considered as the first-line therapy in appropriately selected patients.
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Affiliation(s)
- Gilgamesh Eamer
- Children's Hospital of Eastern Ontario, Ottawa, ON, Canada; Department of Surgery, University of Ottawa, Ottawa, ON, Canada.
| | - Christopher A Povolo
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | | | - Arto Ohinmaa
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Lisa Vanhouwelingen
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada; McMaster Children's Hospital, Hamilton, ON, Canada
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Hallifax RJ. Cost Utility Analysis of Primary Spontaneous Pneumothorax Management: Another Reason to Choose Outpatient Options? Chest 2023; 164:829-830. [PMID: 37805243 DOI: 10.1016/j.chest.2023.06.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 06/27/2023] [Indexed: 10/09/2023] Open
Affiliation(s)
- Rob J Hallifax
- Oxford Respiratory Trials Unit, University of Oxford, Churchill Hospital, Oxford, England.
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8
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Jouneau S, Ricard JD, Seguin-Givelet A, Bigé N, Contou D, Desmettre T, Hugenschmitt D, Kepka S, Le Gloan K, Maitre B, Mangiapan G, Marchand-Adam S, Mariolo A, Marx T, Messika J, Noël-Savina E, Oberlin M, Palmier L, Perruez M, Pichereau C, Roche N, Garnier M, Martinez M. SPLF/SMFU/SRLF/SFAR/SFCTCV Guidelines for the management of patients with primary spontaneous pneumothorax. Ann Intensive Care 2023; 13:88. [PMID: 37725198 PMCID: PMC10509123 DOI: 10.1186/s13613-023-01181-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 08/26/2023] [Indexed: 09/21/2023] Open
Abstract
INTRODUCTION Primary spontaneous pneumothorax (PSP) is the presence of air in the pleural space, occurring in the absence of trauma and known lung disease. Standardized expert guidelines on PSP are needed due to the variety of diagnostic methods, therapeutic strategies and medical and surgical disciplines involved in its management. METHODS Literature review, analysis of the literature according to the GRADE (Grading of Recommendation, Assessment, Development and Evaluation) methodology; proposals for guidelines rated by experts, patients and organizers to reach a consensus. Only expert opinions with strong agreement were selected. RESULTS A large PSP is defined as presence of a visible rim along the entire axillary line between the lung margin and the chest wall and ≥ 2 cm at the hilum level on frontal chest X-ray. The therapeutic strategy depends on the clinical presentation: emergency needle aspiration for tension PSP; in the absence of signs of severity: conservative management (small PSP), needle aspiration or chest tube drainage (large PSP). Outpatient treatment is possible if a dedicated outpatient care system is previously organized. Indications, surgical procedures and perioperative analgesia are detailed. Associated measures, including smoking cessation, are described. CONCLUSION These guidelines are a step towards PSP treatment and follow-up strategy optimization in France.
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Affiliation(s)
- Stéphane Jouneau
- Service de Pneumologie, Centre de Compétences pour les Maladies Pulmonaires Rares, IRSET UMR 1085, Université de Rennes 1, Hôpital Pontchaillou, 2 rue Henri Le Guilloux, Rennes Cedex 9, 35033, Rennes, France
| | - Jean-Damien Ricard
- Université Paris Cité, AP-HP, DMU ESPRIT, Service de Médecine Intensive Réanimation, Hôpital Louis Mourier, 178 Rue des Renouillers, 92700 Colombes, INSERM IAME U1137, Paris, France
| | - Agathe Seguin-Givelet
- Département de Chirurgie, Institut du Thorax Curie-Montsouris, Institut Mutualiste Montsouris, et Université Paris Sorbonne Cite, 42 Bd Jourdan, 75014, Paris, France
| | - Naïke Bigé
- Département Interdisciplinaire d'Organisation du Parcours Patient, Médecine Intensive Réanimation, Gustave Roussy, 114 Rue Edouard Vaillant, 94805, Villejuif, France
| | - Damien Contou
- Réanimation Polyvalente, Centre Hospitalier Victor Dupouy, 69, rue du Lieutenant-colonel Prudhon, 95107, Argenteuil, France
| | - Thibaut Desmettre
- Emergency Department, Laboratory Chrono-environnement, UMR 6249 Centre National de La Recherche Scientifique, CHU Besançon, Université Bourgogne Franche-Comté, 3 Bd Alexandre Fleming, 25000, Besançon, France
| | - Delphine Hugenschmitt
- Samu-Smur 69, CHU Edouard-Herriot, Hospices Civils de Lyon, 5 Pl. d'Arsonval, 69003, Lyon, France
| | - Sabrina Kepka
- Emergency Department, Hôpitaux Universitaires de Strasbourg, Icube UMR 7357, 1 Place de l'hôpital, BP 426, 67091, Strasbourg, France
| | - Karinne Le Gloan
- Emergency Department, Centre Hospitalier Universitaire de Nantes, 5 All. de l'Ile Gloriette, 44000, Nantes, France
| | - Bernard Maitre
- Service de Pneumologie, Centre Hospitalier Intercommunal de Créteil, Unité de Pneumologie, GH Mondor, IMRB U 955, Equipe 8, Université Paris Est Créteil, 40 Av. de Verdun, 94000, Créteil, France
| | - Gilles Mangiapan
- Service de Pneumologie, G-ECHO: Groupe ECHOgraphie Thoracique, Unité de Pneumologie Interventionnelle, Centre Hospitalier Intercommunal de Créteil, 40 Av. de Verdun, 94000, Créteil, France
| | - Sylvain Marchand-Adam
- CHRU de Tours, Service de Pneumologie et Explorations Respiratoires Fonctionnelles, 2, boulevard tonnellé, 37000, Tours, France
| | - Alessio Mariolo
- Département de Chirurgie, Institut du Thorax Curie-Montsouris, Institut Mutualiste Montsouris, 42 Bd Jourdan, 75014, Paris, France
| | - Tania Marx
- Emergency Department, Laboratory Chrono-environnement, UMR 6249 Centre National de La Recherche Scientifique, CHU Besançon, Université Bourgogne Franche-Comté, 3 Bd Alexandre Fleming, 25000, Besançon, France
| | - Jonathan Messika
- Université Paris Cité, Inserm, Physiopathologie et Épidémiologie des Maladies Respiratoires, Service de Pneumologie B et Transplantation Pulmonaire, AP-HP, Hôpital Bichat, 46 Rue Henri Huchard, 75018, Paris, France
| | - Elise Noël-Savina
- Service de Pneumologie et soins Intensifs Respiratoires, G-ECHO: Groupe ECHOgraphie Thoracique, CHU Toulouse, 24 Chemin De Pouvourville, 31059, Toulouse, France
| | - Mathieu Oberlin
- Emergency Department, Hôpitaux Universitaires de Strasbourg, 1 Place de l'hôpital, BP 426, 67091, Strasbourg, France
| | - Ludovic Palmier
- Pôle Anesthésie Réanimation Douleur Urgences, Nîmes University Hospital, 4 Rue du Professeur Robert Debré, 30900, Nîmes, France
| | - Morgan Perruez
- Emergency department, Hôpital Européen Georges Pompidou, 20 Rue Leblanc, 75015, Paris, France
| | - Claire Pichereau
- Médecine Intensive Réanimation, Centre Hospitalier Intercommunal de Poissy Saint Germain, 10 Rue du Champ Gaillard, 78300, Poissy, France.
| | - Nicolas Roche
- Service de Pneumologie, Hôpital Cochin, APHP Centre Université Paris Cité, UMR1016, Institut Cochin, 27 Rue du Faubourg Saint-Jacques, 75014, Paris, France
| | - Marc Garnier
- Sorbonne Université, AP-HP, GRC29, DMU DREAM, Service d'anesthésie-Réanimation et Médecine Périoperatoire Rive Droite, site Tenon, 4 Rue de la Chine, 75020, Paris, France
| | - Mikaël Martinez
- Pôle Urgences, Centre Hospitalier du Forez, & Groupement de Coopération Sanitaire Urgences-ARA, Av. des Monts du Soir, 42600, Montbrison, France
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9
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Joshi P, Sahu G, Pawar KS, Gupta V. Aetiology, clinical profile and management outcome of pneumothorax patients: A prospective study from Central India. J Family Med Prim Care 2023; 12:2134-2139. [PMID: 38024915 PMCID: PMC10657060 DOI: 10.4103/jfmpc.jfmpc_341_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 06/09/2023] [Accepted: 06/19/2023] [Indexed: 12/01/2023] Open
Abstract
Background Pneumothorax (PT) is defined as the presence of air in the pleural cavity. Primary spontaneous pneumothorax (PSP) arises in an otherwise healthy person without any underlying lung disease. PSP occurs in people aged 20 to 30 years, with a peak incidence in the early twenties. The recurrence rate in spontaneous PT patients is approximately 10%-20%. In the present study, 50 cases of spontaneous PT were undertaken with an aim to analyse aetiology, clinical profile and management outcome of PT patients. Materials and Methods The present study was conducted for a period of 12 months, among 50 patients presenting with unilateral PT. The therapeutic interventions were indicated when there was a loss of volume of lungs of 32% or more, and this loss of volume was calculated using Collins method. The association between the side of PT, smoking status and size of PT were found using the Chi-square test, and the association between variables were considered significant if the P value was <0.05. Results In the present study, the male patients were 92.0% and only 8.0% of patients were females. The further history-taking of patients had shown that the mode of onset of PT was sudden in 72.0% of patients. Although the success rate of Intracth procedure was lower in comparison with the intercoastal drainage (ICD) procedure, the complication rate of Intracath was lower when compared with extensive subcutaneous. Conclusion PSP is less common than secondary spontaneous PT. Smoking is an independent risk factor for PT, and it delays its resorbtion.
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Affiliation(s)
- Priyanka Joshi
- Department of Pulmonary Medicine, Mahaveer Institute of Medical Science, Bhopal, Madhya Pradesh, India
| | - Gaurav Sahu
- Department of Pulmonary Medicine, AIIMS, Bhopal, Madhya Pradesh, India
| | - Kamendra Singh Pawar
- Department of Respiratory Medicine, Sri Aurobindo Institute of Medical Sciences and Postgraduate Institute, Indore, Madhya Pradesh, India
| | - Vikas Gupta
- Department of Community Medicine, Birsa Munda Government Medical College, Shahdol, Madhya Pradesh, India
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10
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Barton EC, Maskell NA, Walker SP. Expert Review on Spontaneous Pneumothorax: Advances, Controversies, and New Directions. Semin Respir Crit Care Med 2023. [PMID: 37321247 DOI: 10.1055/s-0043-1769615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
For decades, there has been scanty evidence, most of which is of poor quality, to guide clinicians in the assessment and management of pneumothorax. A recent surge in pneumothorax research has begun to address controversies surrounding the topic and change the face of pneumothorax management. In this article, we review controversies concerning the etiology, pathogenesis, and classification of pneumothorax, and discuss recent advances in its management, including conservative and ambulatory management. We review the evidence base for the challenges of managing pneumothorax, including persistent air leak, and suggest new directions for future research that can help provide patient-centered, evidence-based management for this challenging cohort of patients.
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Affiliation(s)
- Eleanor C Barton
- Academic Respiratory Unit, North Bristol National Health Service Trust, Bristol, United Kingdom
| | - Nick A Maskell
- Academic Respiratory Unit, North Bristol National Health Service Trust, Bristol, United Kingdom
| | - Steven P Walker
- Academic Respiratory Unit, North Bristol National Health Service Trust, Bristol, United Kingdom
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11
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Lee YCG. Primary Spontaneous Pneumothorax: Treat the Patient, Not the X-Ray. Am J Respir Crit Care Med 2023; 207:1416-1417. [PMID: 36892609 PMCID: PMC10263137 DOI: 10.1164/rccm.202302-0273ed] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/10/2023] Open
Affiliation(s)
- Y C Gary Lee
- Respiratory Medicine Sir Charles Gairdner Hospital Perth, Western Australia, Australia
- Faculty of Health & Medical Sciences University of Western Australia Perth, Western Australia, Australia and Pleural Medicine Unit Institute for Respiratory Health Perth, Western Australia, Australia
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12
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Jouneau S, Ricard JD, Seguin-Givelet A, Bigé N, Contou D, Desmettre T, Hugenschmitt D, Kepka S, Gloan KL, Maitre B, Mangiapan G, Marchand-Adam S, Mariolo A, Marx T, Messika J, Noël-Savina E, Oberlin M, Palmier L, Perruez M, Pichereau C, Roche N, Garnier M, Martinez M. SPLF/SMFU/SRLF/SFAR/SFCTCV Guidelines for the management of patients with primary spontaneous pneumothorax: Endorsed by the French Speaking Society of Respiratory Diseases (SPLF), the French Society of Emergency Medicine (SFMU), the French Intensive Care Society (SRLF), the French Society of Anesthesia & Intensive Care Medicine (SFAR) and the French Society of Thoracic and Cardiovascular Surgery (SFCTCV). Respir Med Res 2023; 83:100999. [PMID: 37003203 DOI: 10.1016/j.resmer.2023.100999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 01/22/2023] [Indexed: 04/03/2023]
Abstract
INTRODUCTION Primary spontaneous pneumothorax (PSP) is the presence of air in the pleural space, occurring in the absence of trauma and known lung disease. Standardized expert guidelines on PSP are needed due to the variety of diagnostic methods, therapeutic strategies and medical and surgical disciplines involved in its management. METHODS Literature review, analysis of literature according to the GRADE (Grading of Recommendation Assessment, Development and Evaluation) methodology; proposals for guidelines rated by experts, patients, and organizers to reach a consensus. Only expert opinions with strong agreement were selected. RESULTS A large PSP is defined as presence of a visible rim along the entire axillary line between the lung margin and the chest wall and ≥2 cm at the hilum level on frontal chest x-ray. The therapeutic strategy depends on the clinical presentation: emergency needle aspiration for tension PSP; in the absence of signs of severity: conservative management (small PSP), needle aspiration or chest tube drainage (large PSP). Outpatient treatment is possible if a dedicated outpatient care system is previously organized. Indications, surgical procedures and perioperative analgesia are detailed. Associated measures, including smoking cessation, are described. CONCLUSION These guidelines are a step towards PSP treatment and follow-up strategy optimization in France.
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Affiliation(s)
- Stéphane Jouneau
- Service de Pneumologie, Centre de Compétences pour les Maladies Pulmonaires Rares, IRSET UMR 1085, Université de Rennes 1, Hôpital Pontchaillou, 2 rue Henri Le Guilloux, 35033 Rennes Cedex 9, Rennes 35033, France.
| | - Jean-Damien Ricard
- Université Paris Cité, AP-HP, DMU ESPRIT, Service de Médecine Intensive Réanimation, Hôpital Louis Mourier, 178 Rue des Renouillers, 92700 Colombes ; INSERM IAME U1137, Paris, France
| | - Agathe Seguin-Givelet
- Département de Chirurgie, Institut du Thorax Curie-Montsouris, Institut Mutualiste Montsouris, et Université Paris Sorbonne Cité, 42 Bd Jourdan, Paris 75014, France
| | - Naïke Bigé
- Gustave Roussy, Département Interdisciplinaire d'Organisation du Parcours Patient, Médecine Intensive Réanimation, 114 Rue Edouard Vaillant, Villejuif 94805, France
| | - Damien Contou
- Réanimation Polyvalente, Centre Hospitalier Victor Dupouy, 69, rue du Lieutenant-colonel Prudhon, Argenteuil 95107, France
| | - Thibaut Desmettre
- Emergency Department, CHU Besançon, Laboratory Chrono-environnement, UMR 6249 Centre National de La Recherche Scientifique, Université Bourgogne Franche-Comté, 3 Bd Alexandre Fleming, Besançon 25000, France
| | - Delphine Hugenschmitt
- Samu-Smur 69, CHU Édouard-Herriot, Hospices Civils de Lyon, 5 Pl. d'Arsonval, Lyon 69003, France
| | - Sabrina Kepka
- Emergency Department, Hôpitaux Universitaires de Strasbourg, Icube UMR 7357, 1 place de l'hôpital, Strasbourg BP 426 67091, France
| | - Karinne Le Gloan
- Emergency Department, centre hospitalier universitaire de Nantes, 5 All. de l'Île Gloriette, Nantes 44000, France
| | - Bernard Maitre
- Service de Pneumologie, Centre hospitalier intercommunal de Créteil, Unité de Pneumologie, GH Mondor, IMRB U 955, Equipe 8, Université Paris Est Créteil, 40 Av. de Verdun, Créteil 94000, France
| | - Gilles Mangiapan
- Unité de Pneumologie Interventionnelle, Service de Pneumologie, G-ECHO: Groupe ECHOgraphie thoracique, Centre hospitalier intercommunal de Créteil, 40 Av. de Verdun, Créteil 94000, France
| | - Sylvain Marchand-Adam
- CHRU de Tours, service de pneumologie et explorations respiratoires fonctionnelles, 2, boulevard tonnellé, Tours 37000, France
| | - Alessio Mariolo
- Département de Chirurgie, Institut du Thorax Curie-Montsouris, Institut Mutualiste Montsouris, 42 Bd Jourdan, Paris 75014, France
| | - Tania Marx
- Emergency Department, CHU Besançon, Laboratory Chrono-environnement, UMR 6249 Centre National de La Recherche Scientifique, Université Bourgogne Franche-Comté, 3 Bd Alexandre Fleming, Besançon 25000, France
| | - Jonathan Messika
- Université Paris Cité, Inserm, Physiopathologie et épidémiologie des maladies respiratoires, Service de Pneumologie B et Transplantation Pulmonaire, AP-HP, Hôpital Bichat, 46 Rue Henri Huchard, Paris 75018, France
| | - Elise Noël-Savina
- Service de pneumologie et soins intensifs respiratoires, G-ECHO: Groupe ECHOgraphie thoracique, CHU Toulouse, 24 Chemin De Pouvourville, Toulouse 31059, France
| | - Mathieu Oberlin
- Emergency Department, Hôpitaux Universitaires de Strasbourg, 1 place de l'hôpital, Strasbourg BP 426 67091, France
| | - Ludovic Palmier
- Pôle Anesthésie Réanimation Douleur Urgences, Nîmes University Hospital, 4 Rue du Professeur Robert Debré, Nîmes 30900, France
| | - Morgan Perruez
- Emergency department, Hôpital Européen Georges Pompidou, 20 Rue Leblanc, Paris 75015, France
| | - Claire Pichereau
- Médecine intensive réanimation, Centre Hospitalier Intercommunal de Poissy Saint Germain, 10 rue du champ Gaillard, Poissy 78300, France
| | - Nicolas Roche
- Service de Pneumologie, Hôpital Cochin, APHP Centre Université Paris Cité, UMR1016, Institut Cochin, 27 Rue du Faubourg Saint-Jacques, Paris 75014, France
| | - Marc Garnier
- Sorbonne Université, AP-HP, GRC29, DMU DREAM, service d'anesthésie-réanimation et médecine périoperatoire Rive Droite, site Tenon, 4 Rue de la Chine, Paris 75020, France
| | - Mikaël Martinez
- Pôle Urgences, centre hospitalier du Forez, & Groupement de coopération sanitaire Urgences-ARA, Av. des Monts du Soir, Montbrison 42600, France
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13
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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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14
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Jouneau S, Ricard JD, Seguin-Givelet A, Bigé N, Contou D, Desmettre T, Hugenschmitt D, Kepka S, Le Gloan K, Maitre B, Mangiapan G, Marchand-Adam S, Mariolo A, Marx T, Messika J, Noël-Savina E, Oberlin M, Palmier L, Perruez M, Pichereau C, Roche N, Garnier M, Martinez M. [Guidelines for management of patients with primary spontaneous pneumothorax]. Rev Mal Respir 2023; 40:265-301. [PMID: 36870931 DOI: 10.1016/j.rmr.2023.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 01/04/2023] [Indexed: 03/06/2023]
Affiliation(s)
- S Jouneau
- Service de pneumologie, Centre de compétences pour les maladies pulmonaires rares, hôpital Pontchaillou, IRSET UMR 1085, université de Rennes 1, Rennes, France.
| | - J-D Ricard
- Université Paris Cité, AP-HP, DMU ESPRIT, service de médecine intensive réanimation, hôpital Louis-Mourier, Colombes, France; Inserm IAME U1137, Paris, France
| | - A Seguin-Givelet
- Département de chirurgie, Institut du thorax Curie-Montsouris, Institut Mutualiste Montsouris, université Paris Sorbonne Cité, Paris, France
| | - N Bigé
- Gustave-Roussy, département interdisciplinaire d'organisation du parcours patient, médecine intensive réanimation, Villejuif, France
| | - D Contou
- Réanimation polyvalente, centre hospitalier Victor-Dupouy, Argenteuil, France
| | - T Desmettre
- Emergency department, CHU Besançon, laboratory chrono-environnement, UMR 6249 Centre national de la recherche scientifique, université Bourgogne Franche-Comté, Besançon, France
| | - D Hugenschmitt
- Samu-Smur 69, CHU Édouard-Herriot, hospices civils de Lyon, Lyon, France
| | - S Kepka
- Emergency department, hôpitaux universitaires de Strasbourg, Icube UMR 7357, Strasbourg, France
| | - K Le Gloan
- Emergency department, centre hospitalier universitaire de Nantes, Nantes, France
| | - B Maitre
- Service de pneumologie, centre hospitalier intercommunal de Créteil, unité de pneumologie, GH Mondor, IMRB U 955, équipe 8, université Paris Est Créteil, Créteil, France
| | - G Mangiapan
- Unité de pneumologie interventionnelle, service de pneumologie, Groupe ECHOgraphie thoracique (G-ECHO), centre hospitalier intercommunal de Créteil, Créteil, France
| | - S Marchand-Adam
- CHRU de Tours, service de pneumologie et explorations respiratoires fonctionnelles, Tours, France
| | - A Mariolo
- Département de chirurgie, Institut du thorax Curie-Montsouris, Institut Mutualiste Montsouris, Paris, France
| | - T Marx
- Emergency department, CHU Besançon, laboratory chrono-environnement, UMR 6249 Centre national de la recherche scientifique, université Bourgogne Franche-Comté, Besançon, France
| | - J Messika
- Université Paris Cité, Inserm, physiopathologie et épidémiologie des maladies respiratoires, service de pneumologie B et transplantation pulmonaire, AP-HP, hôpital Bichat, Paris, France
| | - E Noël-Savina
- Service de pneumologie et soins intensifs respiratoires, Groupe ECHOgraphie thoracique (G-ECHO), CHU Toulouse, Toulouse, France
| | - M Oberlin
- Emergency department, hôpitaux universitaires de Strasbourg, Strasbourg, France
| | - L Palmier
- Pôle anesthésie réanimation douleur urgences, Nîmes university hospital, Nîmes, France
| | - M Perruez
- Emergency department, hôpital européen Georges-Pompidou, Paris, France
| | - C Pichereau
- Médecine intensive réanimation, centre hospitalier intercommunal de Poissy Saint-Germain, Poissy, France
| | - N Roche
- Service de pneumologie, hôpital Cochin, AP-HP, centre université Paris Cité, UMR1016, Institut Cochin, Paris, France
| | - M Garnier
- Sorbonne université, AP-HP, GRC29, DMU DREAM, service d'anesthésie-réanimation et médecine périopératoire Rive Droite, site Tenon, Paris, France
| | - M Martinez
- Pôle urgences, centre hospitalier du Forez, Montbrison, France; Groupement de coopération sanitaire urgences-ARA, Lyon, France
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15
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Jouneau S, Ricard JD, Seguin-Givelet A, Bigé N, Contou D, Desmettre T, Hugenschmitt D, Kepka S, Le Gloan K, Maître B, Mangiapan G, Marchand-Adam S, Mariolo A, Marx T, Messika J, Noël-Savina E, Oberlin M, Palmier L, Perruez M, Pichereau C, Roche N, Garnier M, Martinez† M. Recommandations formalisées d’experts pour la prise en charge des pneumothorax spontanés primaires. ANNALES FRANCAISES DE MEDECINE D URGENCE 2023. [DOI: 10.3166/afmu-2022-0472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
Introduction : Le pneumothorax spontané primaire (PSP) est un épanchement gazeux dans la cavité pleurale, survenant hors traumatisme et pathologie respiratoire connue. Des recommandations formalisées d'experts sur le sujet sont justifiées par les pluralités de moyens diagnostiques, stratégies thérapeutiques et disciplines médicochirurgicales intervenant dans leur prise en charge.
Méthodes : Revue bibliographique, analyse de la littérature selon méthodologie GRADE (Grading of Recommendation Assessment, Development and Evaluation) ; propositions de recommandations cotées par experts, patients et organisateurs pour obtenir un consensus. Seuls les avis d'experts avec accord fort ont été retenus.
Résultats : Un décollement sur toute la hauteur de la ligne axillaire et supérieur ou égal à 2 cm au niveau du hile à la radiographie thoracique de face définit la grande abondance. La stratégie thérapeutique dépend de la présentation clinique : exsufflation en urgence pour PSP suffocant ; en l'absence de signe de gravité : prise en charge conservatrice (faible abondance), exsufflation ou drainage (grande abondance). Le traitement ambulatoire est possible si organisation en amont de la filière. Les indications, procédures chirurgicales et l'analgésie périopératoire sont détaillées. Les mesures associées, notamment le sevrage tabagique, sont décrites.
Conclusion : Ces recommandations sont une étape de l'optimisation des stratégies de traitement et de suivi des PSP en France.
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Walker SP, Hallifax R, Rahman NM, Maskell NA. Challenging the Paradigm of Persistent Air Leak: Are We Prolonging the Problem? Am J Respir Crit Care Med 2022; 206:145-149. [PMID: 35353640 DOI: 10.1164/rccm.202109-2149pp] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Affiliation(s)
- Steven P Walker
- Academic Respiratory Unit, University of Bristol, Bristol, United Kingdom; and
| | - Rob Hallifax
- Oxford Respiratory Trials Unit, University of Oxford, Oxford, United Kingdom
| | - Najib M Rahman
- Oxford Respiratory Trials Unit, University of Oxford, Oxford, United Kingdom
| | - Nick A Maskell
- Academic Respiratory Unit, University of Bristol, Bristol, United Kingdom; and
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17
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Daniels JMA. Management of primary spontaneous pneumothorax: don't hesitate, ambulate! Thorax 2022; 77:thoraxjnl-2022-218966. [PMID: 35732491 DOI: 10.1136/thoraxjnl-2022-218966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2022] [Indexed: 11/04/2022]
Affiliation(s)
- Johannes M A Daniels
- Department of Pulmonary Medicine, Amsterdam UMC Locatie VUmc, Amsterdam, the Netherlands
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Çıtak N, Özdemir S. Which pneumothorax volume/size measurement method can best predict surgical indication in primary spontaneous pneumothorax patients? A comparison of six different methods. Gen Thorac Cardiovasc Surg 2022; 70:871-879. [PMID: 35305198 DOI: 10.1007/s11748-022-01800-y] [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: 11/22/2021] [Accepted: 03/03/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We determined whether patients requiring surgery could be identified using pneumothorax volume/size in the first episode of primary spontaneous pneumothorax (PSP) and confirmed which of six different measurement methods of pneumothorax volume/size best predicted surgical indication (prolonged air leak, PAL, or ipsilateral recurrence). METHODS Between 2013 and 2017, 282 patients with PSP were analysed. The volume of the pneumothorax (%) was calculated using volumetric methods (Collins, Rhea, Kircher, Light), while its size (large or small) was determined using the British Thoracic Society (BTS) and American College of Chest Physicians (ACCP) guidelines for the first PSP episode. The optimal cut-off points of pneumothorax volume in patients requiring surgery were based on the most sensitive and specific scores, calculated using receiver operating characteristic analysis. RESULTS Surgery was indicated in 162 patients (57.4%) because of PAL (n = 92) or ipsilateral recurrence (n = 70). Kircher's method had a better area under the curve (AUC) value than the others (AUC = 0.731, 95% confidence interval [CI] 0.676-0.782). Comparing the calculated cut-off points for each volumetric method and the known thresholds from the BTS/ACCP, the best predictor for surgical indications (for both PAL and ipsilateral recurrence) was Kircher's method (odds ratio = 5.636, 95% CI 3.338-9.516, p < 0.001). The four volumetric methods were significantly correlated with pneumothorax volume (rho ≥ 0.8, p < 0.001, for all comparisons). CONCLUSIONS Pneumothorax volume/size calculated in the first PSP episode may help predict surgical candidates, with Kircher's method being the best predictor. There was a correlation between all the volumetric methods of the pneumothorax volume.
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Affiliation(s)
- Necati Çıtak
- Thoracic Surgery, Bakirkoy Dr Sadi Konuk Training and Research Hospital, Tevfik Sağlam Cd. E blok 1.Kat, 34010, Istanbul, Turkey.
| | - Servet Özdemir
- Thoracic Surgery, Bakirkoy Dr Sadi Konuk Training and Research Hospital, Tevfik Sağlam Cd. E blok 1.Kat, 34010, Istanbul, Turkey
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Management of the Secondary Spontaneous Pneumothorax: Current Guidance, Controversies, and Recent Advances. J Clin Med 2022; 11:jcm11051173. [PMID: 35268264 PMCID: PMC8911306 DOI: 10.3390/jcm11051173] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 02/10/2022] [Accepted: 02/15/2022] [Indexed: 02/05/2023] Open
Abstract
Secondary spontaneous pneumothorax (SSP) is a medical emergency where the lung collapses in the presence of underlying chronic lung disease. It is the commonest cause of spontaneous pneumothorax and results in significant breathlessness, higher morbidity, mortality, and longer hospital admissions than with patients with pneumothoraces and no underlying lung disease. This article explores the current guidance, controversies, and recent advances in the management of this condition.
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Effectiveness of Video-Assisted Thoracoscopic Surgery with Bullectomy and Partial Pleurectomy in the Treatment of Primary Spontaneous Pneumothorax-A Retrospective Long-Term Single-Center Analysis. Healthcare (Basel) 2022; 10:healthcare10030410. [PMID: 35326888 PMCID: PMC8953604 DOI: 10.3390/healthcare10030410] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 02/16/2022] [Accepted: 02/19/2022] [Indexed: 02/01/2023] Open
Abstract
Background: Video-assisted thoracoscopic surgery (VATS) with bullectomy and partial pleurectomy (VBPP) is an increasingly used and well-established surgical treatment for primary spontaneous pneumothorax (PSP). However, reports on its effectiveness and long-term outcomes are limited. The aim of this study was to assess and compare long-term recurrence rates following VBPP and chest tube (CT) treatment and to identify potential risk factors for disease recurrence in patients with PSP. Methods: A total of 116 patients treated either by VBPP or CT were included in this study. Long-term recurrence rates and associations between clinical parameters and recurrence of pneumothorax were analyzed. Results: Sixty-two patients (53.4%) underwent VBPP, whereas 54 (46.6%) patients underwent CT treatment only. During a median follow-up period of 76.5 months, VBPP patients experienced a significantly lower recurrence rate compared to CT patients (6/62 vs. 35/54; p < 0.0001). CT treatment (VBPP vs. CT; p < 0.001) and a large initial pneumothorax size (Collins < 4 vs. Collins ≥ 4; p = 0.018) were independent risk factors for pneumothorax recurrence. Conclusion: VBPP is an effective and safe surgical treatment for PSP. Therefore, patients with a large pneumothorax size might benefit from VBPP, as they are at high risk for disease recurrence.
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21
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Quantification of Pneumothorax Volume on Chest X-Ray. J Thorac Imaging 2022; 37:262-268. [DOI: 10.1097/rti.0000000000000636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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22
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Özdemir S, Çitak N. Determination of Risk Factors for Recurrence in First Episode Pneumothorax. Indian J Surg 2022. [DOI: 10.1007/s12262-021-03274-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Abstract
Pneumothorax is a common medical condition encountered in a wide variety of clinical presentations, ranging from asymptomatic to life threatening. When symptomatic, it is important to remove air from the pleural space and provide re-expansion of the lung. Additionally, patients who experience a spontaneous pneumothorax are at high risk for recurrence, so treatment goals also include recurrence prevention. Several recent studies have evaluated less invasive management strategies for pneumothorax, including conservative or outpatient management. Future studies may help to identify who is greatest at risk for recurrence and direct earlier definitive management strategies, including thoracoscopic surgery, to those patients.
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24
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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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Fung S, Alexander A, Ashmawy H, Dizdar L, Safi S, Rehders A, Fluegen G, Knoefel WT. Socioeconomic Impact of Recurrent Primary Spontaneous Pneumothorax: Should Video-Assisted Thoracoscopic Surgery Be Considered at First Episode of Primary Spontaneous Pneumothorax? Healthcare (Basel) 2021; 9:healthcare9091236. [PMID: 34575010 PMCID: PMC8466303 DOI: 10.3390/healthcare9091236] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 09/13/2021] [Accepted: 09/16/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Current guidelines recommend video-assisted thoracoscopic surgery (VATS) for recurrent primary spontaneous pneumothorax (PSP) and for cases with persistent air leak after chest tube treatment. The socioeconomic impact of recurrent PSP on the healthcare system is insufficiently reported. METHODS Ninety-six patients treated for PSP between 01/2010 and 01/2020 were included. Forty-eight patients underwent primary VATS, while the second group received chest tube (CT) treatment only. Length of hospital stay (LOS), duration of chest tube, prolonged air leak, postoperative complications, recurrences and treatment costs were analyzed. RESULTS Prolonged air leaks were evident in 12.5% and 22.9% patients of the VATS and CT group, respectively. Ten (20.8%) patients in the CT group underwent VATS for persistent air leakage. During follow-up, the VATS group recurred at 8.3% compared to 52.1% in the CT group. The total cost of treatment per patient, including treatment cost due to recurrence, was EUR 1.501 in the VATS group and EUR 2.233 in the CT group. CONCLUSIONS Primary treatment of PSP by CT is associated with an increased socioeconomic burden for patients and the healthcare system due to high recurrence rates. This burden may be reduced if VATS is considered at the first episode of PSP.
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Mummadi SR, Porcel JM. Ambulatory management of secondary spontaneous pneumothorax: a mirage, or a solution on the horizon? Eur Respir J 2021; 57:57/6/2100003. [PMID: 34168055 DOI: 10.1183/13993003.00003-2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Accepted: 01/04/2021] [Indexed: 11/05/2022]
Affiliation(s)
| | - José M Porcel
- Pleural Medicine Unit, Dept of Internal Medicine, Arnau de Vilanova University Hospital, IRBLleida, University of Lleida, Lleida, Spain
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Jang HJ, Lee JH, Nam SH, Ro SK. Fate of contralateral asymptomatic bullae in patients with primary spontaneous pneumothorax. Eur J Cardiothorac Surg 2021; 58:365-370. [PMID: 32182337 DOI: 10.1093/ejcts/ezaa054] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 01/20/2020] [Accepted: 01/29/2020] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVES This retrospective cohort study aimed to analyse the impact of asymptomatic blebs/bullae on the occurrence of primary spontaneous pneumothorax (PSP) by monitoring the natural course of contralateral blebs/bullae in patients with ipsilateral pneumothorax. METHODS From January 2003 to December 2017, 1055 patients [age 19.6 ± 3.98 years (mean ± standard deviation), 953 men] experiencing the first episode of unilateral PSP were enrolled in this study, excluding patients aged 30 years or more. The presence, number and maximal size of the blebs/bullae were investigated in contralateral asymptomatic lungs based on high-resolution computed tomography. RESULTS Multiple and single blebs/bullae were noted in contralateral lungs in 425 (40.3%) and 88 (8.3%) patients, respectively. The median follow-up period was 44.0 (interquartile range 71.5) months. The 1-, 3- and 5-year cumulative occurrence rates of PSP in contralateral lungs were 7.9%, 13.7% and 16.7%, respectively. On multivariable analysis, younger age [hazard ratio (HR) 1.19, 95% confidence interval (CI) 1.12-1.27; P < 0.001) and multiple bullae (HR 4.42, 95% CI 3.06-6.38; P < 0.001) were independent risk factors for spontaneous pneumothorax in the contralateral lung. The 5-year cumulative occurrence rates of PSP were significantly higher in patients with multiple blebs/bullae than in those with no or a single bleb/bulla (28.2% vs 8.5%, respectively; P < 0.001). CONCLUSIONS Asymptomatic blebs/bullae often lead to PSP. If the patient is eligible for surgery for pneumothorax, preemptive surgery for contralateral bullae could be considered, especially in patients with multiple blebs/bullae.
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Affiliation(s)
- Hyo Jun Jang
- Department of Thoracic and Cardiovascular Surgery, Hanyang University Seoul Hospital, Hanyang University College of Medicine, Seoul, Korea
| | - Jun Ho Lee
- Department of Thoracic and Cardiovascular Surgery, Hanyang University Seoul Hospital, Hanyang University College of Medicine, Seoul, Korea
| | - Seung Hyuk Nam
- Department of Thoracic and Cardiovascular Surgery, Hanyang University Guri Hospital, Hanyang University College of Medicine, Seoul, Korea
| | - Sun Kyun Ro
- Department of Thoracic and Cardiovascular Surgery, Hanyang University Guri Hospital, Hanyang University College of Medicine, Seoul, Korea
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Primary spontaneous pneumothorax in children: A single institutional experience. Asian J Surg 2021; 44:969-973. [PMID: 33581946 DOI: 10.1016/j.asjsur.2021.01.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 01/18/2021] [Accepted: 01/21/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The treatment of primary spontaneous pneumothorax (PSP) remains controversial. We aimed to examine the role of chest computed tomography (CT), the advantages of pigtail catheter versus chest tube regarding duration of drainage or hospitalization period, and the impact of small PSP and surgical treatment on recurrence rate. METHODS We retrospectively reviewed the medical records of 109 children with PSP (20 years' period). Patients with recurrent and those with non-recurrent PSP were compared. RESULTS We recorded 183 episodes of PSP (45% recurrences), 89 patients (97%) were male, and the median age at presentation was 16 years. There were no significant differences between recurrence and non-recurrence PSP regarding age, gender, medical background, presentation symptoms, type of chest drain, median hospitalization length and median follow-up period. Recurrences were less frequent among patients who presented with small PSP and were treated conservatively (P = 0.029). PSP was almost always unilateral and the recurrence was observed ipsilateral in almost 80% of the cases. CT was more frequently used and blebs/bullae were more frequently found among patients with recurrent PSP. Pigtail use had no advantage in reducing hospitalization period and surgical procedures prevented recurrences. CONCLUSION The size of pneumothorax at presentation helps to predict recurrences. There are no differences regarding duration of drainage or hospitalization period in the use of pigtail compared to chest tube. CT helps evaluate findings in the lungs in recurrent cases of PSP and surgery prevents recurrences effectively.
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29
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Voice training induced spontaneous pneumothorax. Respir Med Case Rep 2020; 31:101304. [PMID: 33304808 PMCID: PMC7708849 DOI: 10.1016/j.rmcr.2020.101304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 11/11/2020] [Accepted: 11/21/2020] [Indexed: 11/21/2022] Open
Abstract
Background Voice training induced spontaneous pneumothorax is seldom reported in the literature. This study reports a case of middle-aged man without comorbidities who presented with spontaneous pneumothorax following voice training and made a complete recovery after CT guided needle thoracostomy. Case report This is a case of a middle-aged male non-smoker with ectomorphic build who presented with chest pain of sudden onset and difficulty in breathing following voice training. The chest pain was central, radiated to the left shoulder and aggravated by lying supine. Chest auscultation revealed reduced breath sounds on the left middle and lower lung zones posteriorly.An initial diagnosis of chest pain of unknown origin was made. Chest radiograph done revealed a left sided pneumothorax, with no background lung pathology seen. Chest CT was done to rule out any underlying pathology, to quantify the pneumothorax and to plan for CT guided needle thoracostomy at our institution.Complete resolution of the left sided pneumothorax was seen after the procedure. Conclusion Voice training is a rare cause of primary spontaneous pneumothorax. In the absence of any other lung pathology, it can be effectively managed by CT guided needle thoracostomy as seen in the index patient.It is essential for emergency physicians to include voice training as a potential cause for primary spontaneous pneumothorax.
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Jouneau S, Vuillard C, Salé A, Bazin Y, Sohier L, Kerjouan M, Ricard JD, Messika J. Outpatient management of primary spontaneous pneumothorax. Respir Med 2020; 176:106240. [PMID: 33248364 DOI: 10.1016/j.rmed.2020.106240] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 11/10/2020] [Accepted: 11/16/2020] [Indexed: 01/01/2023]
Abstract
The outpatient management of primary spontaneous pneumothorax (PSP) is still debated. The risk of a tension pneumothorax is used to justify active treatment like chest-tube drainage, although outpatient management can reduce both the time in hospital and the cost of treatment. It is also likely to be the patient's choice. This report is a reappraisal of the situations for which outpatient management, by monitoring alone, or using minimally invasive techniques, can be considered.
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Affiliation(s)
- Stéphane Jouneau
- Service de Pneumologie, Centre de Compétences pour Les Maladies Pulmonaires Rares, Hôpital Pontchaillou, Rennes, France; IRSET UMR, 1085, Université de Rennes 1, Rennes, France
| | - Constance Vuillard
- Service de Réanimation Médico-Chirurgicale, AP-HP.Nord - Université de Paris, Hôpital Louis Mourier, F-92700, Colombes, France
| | - Alexandre Salé
- Service de Pneumologie, Centre de Compétences pour Les Maladies Pulmonaires Rares, Hôpital Pontchaillou, Rennes, France
| | - Yann Bazin
- Service des Maladies Respiratoires et Infectieuses, Hôpital Broussais, 35400, Saint-Malo, France
| | - Laurent Sohier
- Service de Pneumologie, Centre Hospitalier Bretagne Sud, Lorient, France
| | - Mallorie Kerjouan
- Service de Pneumologie, Centre de Compétences pour Les Maladies Pulmonaires Rares, Hôpital Pontchaillou, Rennes, France
| | - Jean-Damien Ricard
- Service de Réanimation Médico-Chirurgicale, AP-HP.Nord - Université de Paris, Hôpital Louis Mourier, F-92700, Colombes, France; Université de Paris, Infection, Antimicrobials, Modelling, Evolution, IAME, UMR 1137, INSERM, F, 75018, Paris, France
| | - Jonathan Messika
- Service de Pneumologie B et Transplantation Pulmonaire, AP-HP.Nord - Université de Paris, Hôpital Bichat-Claude Bernard, F-75018, Paris, France; Université de Paris, Physiopathology and Epidemiology of Respiratory Diseases, PHERE, UMR1152, INSERM, F-75018 Paris, France.
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31
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Tsuboshima K, Kurihara M, Nonaka Y, Ochi T. Is conventional management of primary spontaneous pneumothorax appropriate? Gen Thorac Cardiovasc Surg 2020; 69:716-721. [PMID: 33180257 DOI: 10.1007/s11748-020-01535-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Accepted: 10/20/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE This study aimed to evaluate the recurrence rate after primary and secondary conservative treatments and to clarify the validity of current primary spontaneous pneumothorax management by comparing secondary conservative treatment and surgical outcomes. METHODS Data from 166 patients with primary spontaneous pneumothorax treated at a single site between September 2015 and March 2019 were retrospectively evaluated. Patient characteristics of those who received primary conservative therapy (n = 166) and secondary conservative therapy (n = 28) were summarized. The outcomes from patients who experienced recurrence (n = 64) were compared based on those who underwent surgery (n = 24) and those who underwent secondary conservative therapy (n = 28). RESULTS The post-treatment day 60 recurrence rate was 27.1 and 49.5% cases in the primary and secondary treatment groups, respectively, which was significantly higher after secondary treatment than after primary treatment with conservative therapy (p = 0.032). The post-treatment one-year recurrence rate was 13.5 and 57.9% in patients who underwent surgery and secondary conservative treatment, respectively; secondary conservative treatment resulted in a significantly higher recurrence rate than surgery (p < 0.001). CONCLUSIONS There is evidence for guidelines that recommend surgery for recurrent primary spontaneous pneumothorax after primary conservative therapy based on its lower and more delayed post-treatment recurrence rate than secondary treatment with conservative therapy.
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Affiliation(s)
- Kenji Tsuboshima
- Pneumothorax Research Center and Division of Thoracic Surgery, Nissan Tamagawa Hospital, 4-8-1 Seta Setagaya-ku, Tokyo, 158-0095, Japan
| | - Masatoshi Kurihara
- Pneumothorax Research Center and Division of Thoracic Surgery, Nissan Tamagawa Hospital, 4-8-1 Seta Setagaya-ku, Tokyo, 158-0095, Japan.
| | - Yuto Nonaka
- Pneumothorax Research Center and Division of Thoracic Surgery, Nissan Tamagawa Hospital, 4-8-1 Seta Setagaya-ku, Tokyo, 158-0095, Japan
| | - Takahiro Ochi
- Pneumothorax Research Center and Division of Thoracic Surgery, Nissan Tamagawa Hospital, 4-8-1 Seta Setagaya-ku, Tokyo, 158-0095, Japan
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Jouneau S, Sohier L, Bazin Y, Salé A, Messika J. Conservative management of primary spontaneous pneumothorax: A failed revolution? Respir Med Res 2020; 79:100796. [PMID: 33242735 DOI: 10.1016/j.resmer.2020.100796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 10/29/2020] [Indexed: 11/25/2022]
Affiliation(s)
- S Jouneau
- Department of respiratory medicine, competence centre for rare pulmonary diseases, CHU Rennes, Rennes, France; UMR_S 1085, Inserm, EHESP, institut de recherche en santé, environnement et travail (IRSET), CHU Rennes, university Rennes, 35000 Rennes, France.
| | - L Sohier
- Department of respiratory medicine, centre hospitalier Bretagne Sud, Lorient, France
| | - Y Bazin
- Department of respiratory medicine, centre hospitalier de Saint-Malo, Saint-Malo, France
| | - A Salé
- Department of respiratory medicine, competence centre for rare pulmonary diseases, CHU Rennes, Rennes, France
| | - J Messika
- Inserm UMR 1152, université de Paris, hôpital Bichat Claude-Bernard, AP-HP nord, Paris, France
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Kunisaki SM, Leys CM. Surgical Pulmonary and Pleural Diseases in Children: Lung Malformations, Empyema, and Spontaneous Pneumothorax. Adv Pediatr 2020; 67:145-169. [PMID: 32591058 DOI: 10.1016/j.yapd.2020.03.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Shaun M Kunisaki
- Division of General Pediatric Surgery, Johns Hopkins Children's Center, Johns Hopkins University, Johns Hopkins University School of Medicine, 1800 Orleans Street, Suite 7353, Baltimore, MD 21287, USA.
| | - Charles M Leys
- Division of Pediatric Surgery, University of Wisconsin School of Medicine and Public Health, American Family Children's Hospital, 600 Highland Avenue, H4/740 CSC, Madison, WI 53792-7375, USA
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Valencia Salazar JC, Zamarriego RJ, Bejarano Castro M, Arzayuz Patiño L. Drenaje percutáneo con catéter del neumotórax en pacientes con COVID–19. REVISTA COLOMBIANA DE CIRUGÍA 2020. [DOI: 10.30944/20117582.772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Introducción: La transmisión del SARS-CoV-2 principalmente se da por gotas y contacto cercano con las personas infectadas, pero los aerosoles parecen ser también una fuente de infección. El neumotórax espontáneo o secundario puede presentarse en pacientes con COVID-19, ayudado por patologías de base como la enfermedad pulmonar obstructiva crónica. Es necesario garantizar procedimientos seguros para los pacientes y buscar todas las medidas posibles para la protección del personal de la salud, por eso el drenaje de neumotórax con catéter pleural en lugar de sonda de toracostomía puede ser una de ellas.
El objetivo de este estudio es presentar a los cirujanos una alternativa a la toracostomía tradicional, mediante la utilización de catéteres de menor diámetro, para la resolución de la ocupación pleural.
Aspectos Técnicos: Se presenta el protocolo para inserción segura de un catéter pleural para el drenaje de neumotórax, mediante un sistema completamente cerrado, y se dan recomendaciones sobre el uso de filtros virales y solución viricida en el sistema de drenaje pleural conectado al catéter.
Conclusión: El estado de pandemia por COVID-19 y el riesgo que representa para los profesionales de la salud la exposición a fuentes de transmisión durante procedimientos generadores de aerosoles, hace que se deban extremar las medidas para evitar el contagio.
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35
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Jeon HW, Kim YD, Sim SB. Use of imaging studies to predict postoperative recurrences of primary spontaneous pneumothorax. J Thorac Dis 2020; 12:2683-2690. [PMID: 32642176 PMCID: PMC7330309 DOI: 10.21037/jtd.2019.11.46] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background Bullectomy with pleural procedure is the most effective means of treating primary spontaneous pneumothorax (PSP). However, recurrences after thoracoscopic bullectomy are unexpectedly frequent. Our aim was to identify the premonitory imaging features after thoracoscopic bullectomy that may associate with recurrences in PSP. Methods The medical records of all patients undergoing thoracoscopic bullectomy for PSP between January 2013 and September 2016 were subject to review. A total of 154 procedures performed on 147 patients qualified for study. Clinical outcomes and characteristics of patients were reviewed and serial chest radiographies were assessed, analyzing risk factors for postoperative recurrences. Results Median age of the male-predominant cohort (93.5%) was 19 (range, 15–39) years. Median operative time was 35 min, none reflecting complications. Postoperatively, diaphragmatic tenting was identified in 78 patients (50.6%), and pleural residual cavity was identified by chest radiography in 102 (66.2%). After discharge, remained diaphragmatic tenting (38/154, 24.7%) and pleural residual cavity (52/154, 33.8%) were identified by chest radiography. In univariate analysis, remained diaphragmatic tenting (P=0.026) and length of pleural residual cavity (P=0.024) emerged as risk factors for recurrence; and both reached significance in multivariate analysis (P=0.020 and P=0.018, respectively). Conclusions Remained diaphragmatic tenting after thoracoscopic surgery for PSP may be associated with the risk of postoperative recurrence.
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Affiliation(s)
- Hyun Woo Jeon
- Department of Thoracic and Cardiovascular Surgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Seoul, Republic of Korea
| | - Young-Du Kim
- Department of Thoracic and Cardiovascular Surgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Seoul, Republic of Korea
| | - Sung Bo Sim
- Department of Thoracic and Cardiovascular Surgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Seoul, Republic of Korea
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Comparative Effectiveness of Interventions in Initial Management of Spontaneous Pneumothorax: A Systematic Review and a Bayesian Network Meta-analysis. Ann Emerg Med 2020; 76:88-102. [DOI: 10.1016/j.annemergmed.2020.01.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Revised: 12/08/2019] [Accepted: 01/02/2020] [Indexed: 12/14/2022]
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Recurrence of primary spontaneous pneumothorax: Associated factors. Pulmonology 2020; 28:276-283. [PMID: 32601016 DOI: 10.1016/j.pulmoe.2020.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 05/30/2020] [Accepted: 06/02/2020] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Determining the risk of recurrence of primary spontaneous pneumothorax is challenging. The objective of this study was to develop a risk assessment model to predict the probability of recurrence in patients with spontaneous pneumothorax. METHODS A retrospective study was performed of all episodes of pneumothorax diagnosed in the last 12 years in a hospital, in patients not initially submitted to surgery. Logistic regression was used to estimate the probability of recurrence. Based on a set of variables, a predictive model was built with its corresponding ROC curve to determine its discrimination power and diagnostic precision. RESULTS Of the 253 patients included, 128 (50.6%) experienced recurrence (37% within the first year). Recurrence was detected within 110 days in 25% of patients. The median of time to recurrence for the whole population was 1120 days. The presence of blebs/bullae was found to be a risk factor of recurrence (OR: 5.34; 95% CI: 2.81-10.23; p=0.000), whereas chest drainage exerted protective effect (OR: 0.19; 95% CI: 0.08-0.40; p=0.000). The variables included in the regression model constructed were hemoglobin and leukocyte count in blood, treatment received, and presence of blebs/bullae, with a fair discriminative power to predict recurrence [AUC=0.778 (95% CI: 0.721-0.835)]. CONCLUSION The overall recurrence rate was high and was associated with the presence of blebs/bullae, failure to perform an active intervention (chest drainage) and low levels of hemoglobin and leukocytes in blood. Recurrence rarely occurs later than three years after the first episode. Once validated, this precision model could be useful to guide therapeutic decisions.
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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: 8] [Impact Index Per Article: 2.0] [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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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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Brown SGA, Ball EL, Perrin K, Asha SE, Braithwaite I, Egerton-Warburton D, Jones PG, Keijzers G, Kinnear FB, Kwan BCH, Lam KV, Lee YCG, Nowitz M, Read CA, Simpson G, Smith JA, Summers QA, Weatherall M, Beasley R. Conservative versus Interventional Treatment for Spontaneous Pneumothorax. N Engl J Med 2020; 382:405-415. [PMID: 31995686 DOI: 10.1056/nejmoa1910775] [Citation(s) in RCA: 143] [Impact Index Per Article: 35.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Whether conservative management is an acceptable alternative to interventional management for uncomplicated, moderate-to-large primary spontaneous pneumothorax is unknown. METHODS In this open-label, multicenter, noninferiority trial, we recruited patients 14 to 50 years of age with a first-known, unilateral, moderate-to-large primary spontaneous pneumothorax. Patients were randomly assigned to immediate interventional management of the pneumothorax (intervention group) or a conservative observational approach (conservative-management group) and were followed for 12 months. The primary outcome was lung reexpansion within 8 weeks. RESULTS A total of 316 patients underwent randomization (154 patients to the intervention group and 162 to the conservative-management group). In the conservative-management group, 25 patients (15.4%) underwent interventions to manage the pneumothorax, for reasons prespecified in the protocol, and 137 (84.6%) did not undergo interventions. In a complete-case analysis in which data were not available for 23 patients in the intervention group and 37 in the conservative-management group, reexpansion within 8 weeks occurred in 129 of 131 patients (98.5%) with interventional management and in 118 of 125 (94.4%) with conservative management (risk difference, -4.1 percentage points; 95% confidence interval [CI], -8.6 to 0.5; P = 0.02 for noninferiority); the lower boundary of the 95% confidence interval was within the prespecified noninferiority margin of -9 percentage points. In a sensitivity analysis in which all missing data after 56 days were imputed as treatment failure (with reexpansion in 129 of 138 patients [93.5%] in the intervention group and in 118 of 143 [82.5%] in the conservative-management group), the risk difference of -11.0 percentage points (95% CI, -18.4 to -3.5) was outside the prespecified noninferiority margin. Conservative management resulted in a lower risk of serious adverse events or pneumothorax recurrence than interventional management. CONCLUSIONS Although the primary outcome was not statistically robust to conservative assumptions about missing data, the trial provides modest evidence that conservative management of primary spontaneous pneumothorax was noninferior to interventional management, with a lower risk of serious adverse events. (Funded by the Emergency Medicine Foundation and others; PSP Australian New Zealand Clinical Trials Registry number, ACTRN12611000184976.).
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Affiliation(s)
- Simon G A Brown
- From the Centre for Clinical Research in Emergency Medicine, Harry Perkins Institute of Medical Research, Royal Perth Hospital, and the University of Western Australia (S.G.A.B., E.L.B., C.A.R.), Royal Perth Hospital Imaging (K.V.L.) and the Respiratory Department (E.L.B., Q.A.S.), Royal Perth Hospital, the Department of Respiratory Medicine, Sir Charles Gairdner Hospital (Y.C.G.L.), and the Centre for Respiratory Health, School of Medicine and Pharmacology, University of Western Australia (Y.C.G.L.), Perth, Aeromedical and Retrieval Services, Ambulance Tasmania (S.G.A.B.), and the Department of Respiratory Medicine, Royal Hobart Hospital (E.L.B.), Hobart, the Emergency Department, St. George Hospital, Kogarah, NSW (S.E.A.), St. George Clinical School, Faculty of Medicine, University of New South Wales, Kensington (S.E.A., B.C.H.K.), the Emergency Department, Monash Medical Centre (D.E.-W.), the Departments of Medicine (D.E.-W.) and Surgery (J.A.S.), School of Clinical Sciences at Monash Health, Monash University, and the Department of Cardiothoracic Surgery, Monash Health (J.A.S.), Clayton, VIC, the Emergency Department, Gold Coast Health Service District, the School of Medicine, Bond University, and the School of Medicine, Griffith University, Gold Coast, QLD (G.K.), Emergency Medical and Children's Services, Prince Charles Hospital, Chermside, QLD (F.B.K.), the University of Queensland, Brisbane (F.B.K.), the Department of Respiratory and Sleep Medicine, Sutherland Hospital, Sydney (B.C.H.K.), and the Department of Respiratory Medicine, Cairns Hospital, Cairns, QLD (G.S.) - all in Australia; the Medical Research Institute of New Zealand (K.P., I.B., M.W., R.B.), the Capital and Coast District Health Board (K.P., M.W., R.B.), and Pacific Radiology (M.N.), Wellington, and the Adult Emergency Department, Auckland City Hospital and University of Auckland, Auckland (P.G.J.) - all in New Zealand
| | - Emma L Ball
- From the Centre for Clinical Research in Emergency Medicine, Harry Perkins Institute of Medical Research, Royal Perth Hospital, and the University of Western Australia (S.G.A.B., E.L.B., C.A.R.), Royal Perth Hospital Imaging (K.V.L.) and the Respiratory Department (E.L.B., Q.A.S.), Royal Perth Hospital, the Department of Respiratory Medicine, Sir Charles Gairdner Hospital (Y.C.G.L.), and the Centre for Respiratory Health, School of Medicine and Pharmacology, University of Western Australia (Y.C.G.L.), Perth, Aeromedical and Retrieval Services, Ambulance Tasmania (S.G.A.B.), and the Department of Respiratory Medicine, Royal Hobart Hospital (E.L.B.), Hobart, the Emergency Department, St. George Hospital, Kogarah, NSW (S.E.A.), St. George Clinical School, Faculty of Medicine, University of New South Wales, Kensington (S.E.A., B.C.H.K.), the Emergency Department, Monash Medical Centre (D.E.-W.), the Departments of Medicine (D.E.-W.) and Surgery (J.A.S.), School of Clinical Sciences at Monash Health, Monash University, and the Department of Cardiothoracic Surgery, Monash Health (J.A.S.), Clayton, VIC, the Emergency Department, Gold Coast Health Service District, the School of Medicine, Bond University, and the School of Medicine, Griffith University, Gold Coast, QLD (G.K.), Emergency Medical and Children's Services, Prince Charles Hospital, Chermside, QLD (F.B.K.), the University of Queensland, Brisbane (F.B.K.), the Department of Respiratory and Sleep Medicine, Sutherland Hospital, Sydney (B.C.H.K.), and the Department of Respiratory Medicine, Cairns Hospital, Cairns, QLD (G.S.) - all in Australia; the Medical Research Institute of New Zealand (K.P., I.B., M.W., R.B.), the Capital and Coast District Health Board (K.P., M.W., R.B.), and Pacific Radiology (M.N.), Wellington, and the Adult Emergency Department, Auckland City Hospital and University of Auckland, Auckland (P.G.J.) - all in New Zealand
| | - Kyle Perrin
- From the Centre for Clinical Research in Emergency Medicine, Harry Perkins Institute of Medical Research, Royal Perth Hospital, and the University of Western Australia (S.G.A.B., E.L.B., C.A.R.), Royal Perth Hospital Imaging (K.V.L.) and the Respiratory Department (E.L.B., Q.A.S.), Royal Perth Hospital, the Department of Respiratory Medicine, Sir Charles Gairdner Hospital (Y.C.G.L.), and the Centre for Respiratory Health, School of Medicine and Pharmacology, University of Western Australia (Y.C.G.L.), Perth, Aeromedical and Retrieval Services, Ambulance Tasmania (S.G.A.B.), and the Department of Respiratory Medicine, Royal Hobart Hospital (E.L.B.), Hobart, the Emergency Department, St. George Hospital, Kogarah, NSW (S.E.A.), St. George Clinical School, Faculty of Medicine, University of New South Wales, Kensington (S.E.A., B.C.H.K.), the Emergency Department, Monash Medical Centre (D.E.-W.), the Departments of Medicine (D.E.-W.) and Surgery (J.A.S.), School of Clinical Sciences at Monash Health, Monash University, and the Department of Cardiothoracic Surgery, Monash Health (J.A.S.), Clayton, VIC, the Emergency Department, Gold Coast Health Service District, the School of Medicine, Bond University, and the School of Medicine, Griffith University, Gold Coast, QLD (G.K.), Emergency Medical and Children's Services, Prince Charles Hospital, Chermside, QLD (F.B.K.), the University of Queensland, Brisbane (F.B.K.), the Department of Respiratory and Sleep Medicine, Sutherland Hospital, Sydney (B.C.H.K.), and the Department of Respiratory Medicine, Cairns Hospital, Cairns, QLD (G.S.) - all in Australia; the Medical Research Institute of New Zealand (K.P., I.B., M.W., R.B.), the Capital and Coast District Health Board (K.P., M.W., R.B.), and Pacific Radiology (M.N.), Wellington, and the Adult Emergency Department, Auckland City Hospital and University of Auckland, Auckland (P.G.J.) - all in New Zealand
| | - Stephen E Asha
- From the Centre for Clinical Research in Emergency Medicine, Harry Perkins Institute of Medical Research, Royal Perth Hospital, and the University of Western Australia (S.G.A.B., E.L.B., C.A.R.), Royal Perth Hospital Imaging (K.V.L.) and the Respiratory Department (E.L.B., Q.A.S.), Royal Perth Hospital, the Department of Respiratory Medicine, Sir Charles Gairdner Hospital (Y.C.G.L.), and the Centre for Respiratory Health, School of Medicine and Pharmacology, University of Western Australia (Y.C.G.L.), Perth, Aeromedical and Retrieval Services, Ambulance Tasmania (S.G.A.B.), and the Department of Respiratory Medicine, Royal Hobart Hospital (E.L.B.), Hobart, the Emergency Department, St. George Hospital, Kogarah, NSW (S.E.A.), St. George Clinical School, Faculty of Medicine, University of New South Wales, Kensington (S.E.A., B.C.H.K.), the Emergency Department, Monash Medical Centre (D.E.-W.), the Departments of Medicine (D.E.-W.) and Surgery (J.A.S.), School of Clinical Sciences at Monash Health, Monash University, and the Department of Cardiothoracic Surgery, Monash Health (J.A.S.), Clayton, VIC, the Emergency Department, Gold Coast Health Service District, the School of Medicine, Bond University, and the School of Medicine, Griffith University, Gold Coast, QLD (G.K.), Emergency Medical and Children's Services, Prince Charles Hospital, Chermside, QLD (F.B.K.), the University of Queensland, Brisbane (F.B.K.), the Department of Respiratory and Sleep Medicine, Sutherland Hospital, Sydney (B.C.H.K.), and the Department of Respiratory Medicine, Cairns Hospital, Cairns, QLD (G.S.) - all in Australia; the Medical Research Institute of New Zealand (K.P., I.B., M.W., R.B.), the Capital and Coast District Health Board (K.P., M.W., R.B.), and Pacific Radiology (M.N.), Wellington, and the Adult Emergency Department, Auckland City Hospital and University of Auckland, Auckland (P.G.J.) - all in New Zealand
| | - Irene Braithwaite
- From the Centre for Clinical Research in Emergency Medicine, Harry Perkins Institute of Medical Research, Royal Perth Hospital, and the University of Western Australia (S.G.A.B., E.L.B., C.A.R.), Royal Perth Hospital Imaging (K.V.L.) and the Respiratory Department (E.L.B., Q.A.S.), Royal Perth Hospital, the Department of Respiratory Medicine, Sir Charles Gairdner Hospital (Y.C.G.L.), and the Centre for Respiratory Health, School of Medicine and Pharmacology, University of Western Australia (Y.C.G.L.), Perth, Aeromedical and Retrieval Services, Ambulance Tasmania (S.G.A.B.), and the Department of Respiratory Medicine, Royal Hobart Hospital (E.L.B.), Hobart, the Emergency Department, St. George Hospital, Kogarah, NSW (S.E.A.), St. George Clinical School, Faculty of Medicine, University of New South Wales, Kensington (S.E.A., B.C.H.K.), the Emergency Department, Monash Medical Centre (D.E.-W.), the Departments of Medicine (D.E.-W.) and Surgery (J.A.S.), School of Clinical Sciences at Monash Health, Monash University, and the Department of Cardiothoracic Surgery, Monash Health (J.A.S.), Clayton, VIC, the Emergency Department, Gold Coast Health Service District, the School of Medicine, Bond University, and the School of Medicine, Griffith University, Gold Coast, QLD (G.K.), Emergency Medical and Children's Services, Prince Charles Hospital, Chermside, QLD (F.B.K.), the University of Queensland, Brisbane (F.B.K.), the Department of Respiratory and Sleep Medicine, Sutherland Hospital, Sydney (B.C.H.K.), and the Department of Respiratory Medicine, Cairns Hospital, Cairns, QLD (G.S.) - all in Australia; the Medical Research Institute of New Zealand (K.P., I.B., M.W., R.B.), the Capital and Coast District Health Board (K.P., M.W., R.B.), and Pacific Radiology (M.N.), Wellington, and the Adult Emergency Department, Auckland City Hospital and University of Auckland, Auckland (P.G.J.) - all in New Zealand
| | - Diana Egerton-Warburton
- From the Centre for Clinical Research in Emergency Medicine, Harry Perkins Institute of Medical Research, Royal Perth Hospital, and the University of Western Australia (S.G.A.B., E.L.B., C.A.R.), Royal Perth Hospital Imaging (K.V.L.) and the Respiratory Department (E.L.B., Q.A.S.), Royal Perth Hospital, the Department of Respiratory Medicine, Sir Charles Gairdner Hospital (Y.C.G.L.), and the Centre for Respiratory Health, School of Medicine and Pharmacology, University of Western Australia (Y.C.G.L.), Perth, Aeromedical and Retrieval Services, Ambulance Tasmania (S.G.A.B.), and the Department of Respiratory Medicine, Royal Hobart Hospital (E.L.B.), Hobart, the Emergency Department, St. George Hospital, Kogarah, NSW (S.E.A.), St. George Clinical School, Faculty of Medicine, University of New South Wales, Kensington (S.E.A., B.C.H.K.), the Emergency Department, Monash Medical Centre (D.E.-W.), the Departments of Medicine (D.E.-W.) and Surgery (J.A.S.), School of Clinical Sciences at Monash Health, Monash University, and the Department of Cardiothoracic Surgery, Monash Health (J.A.S.), Clayton, VIC, the Emergency Department, Gold Coast Health Service District, the School of Medicine, Bond University, and the School of Medicine, Griffith University, Gold Coast, QLD (G.K.), Emergency Medical and Children's Services, Prince Charles Hospital, Chermside, QLD (F.B.K.), the University of Queensland, Brisbane (F.B.K.), the Department of Respiratory and Sleep Medicine, Sutherland Hospital, Sydney (B.C.H.K.), and the Department of Respiratory Medicine, Cairns Hospital, Cairns, QLD (G.S.) - all in Australia; the Medical Research Institute of New Zealand (K.P., I.B., M.W., R.B.), the Capital and Coast District Health Board (K.P., M.W., R.B.), and Pacific Radiology (M.N.), Wellington, and the Adult Emergency Department, Auckland City Hospital and University of Auckland, Auckland (P.G.J.) - all in New Zealand
| | - Peter G Jones
- From the Centre for Clinical Research in Emergency Medicine, Harry Perkins Institute of Medical Research, Royal Perth Hospital, and the University of Western Australia (S.G.A.B., E.L.B., C.A.R.), Royal Perth Hospital Imaging (K.V.L.) and the Respiratory Department (E.L.B., Q.A.S.), Royal Perth Hospital, the Department of Respiratory Medicine, Sir Charles Gairdner Hospital (Y.C.G.L.), and the Centre for Respiratory Health, School of Medicine and Pharmacology, University of Western Australia (Y.C.G.L.), Perth, Aeromedical and Retrieval Services, Ambulance Tasmania (S.G.A.B.), and the Department of Respiratory Medicine, Royal Hobart Hospital (E.L.B.), Hobart, the Emergency Department, St. George Hospital, Kogarah, NSW (S.E.A.), St. George Clinical School, Faculty of Medicine, University of New South Wales, Kensington (S.E.A., B.C.H.K.), the Emergency Department, Monash Medical Centre (D.E.-W.), the Departments of Medicine (D.E.-W.) and Surgery (J.A.S.), School of Clinical Sciences at Monash Health, Monash University, and the Department of Cardiothoracic Surgery, Monash Health (J.A.S.), Clayton, VIC, the Emergency Department, Gold Coast Health Service District, the School of Medicine, Bond University, and the School of Medicine, Griffith University, Gold Coast, QLD (G.K.), Emergency Medical and Children's Services, Prince Charles Hospital, Chermside, QLD (F.B.K.), the University of Queensland, Brisbane (F.B.K.), the Department of Respiratory and Sleep Medicine, Sutherland Hospital, Sydney (B.C.H.K.), and the Department of Respiratory Medicine, Cairns Hospital, Cairns, QLD (G.S.) - all in Australia; the Medical Research Institute of New Zealand (K.P., I.B., M.W., R.B.), the Capital and Coast District Health Board (K.P., M.W., R.B.), and Pacific Radiology (M.N.), Wellington, and the Adult Emergency Department, Auckland City Hospital and University of Auckland, Auckland (P.G.J.) - all in New Zealand
| | - Gerben Keijzers
- From the Centre for Clinical Research in Emergency Medicine, Harry Perkins Institute of Medical Research, Royal Perth Hospital, and the University of Western Australia (S.G.A.B., E.L.B., C.A.R.), Royal Perth Hospital Imaging (K.V.L.) and the Respiratory Department (E.L.B., Q.A.S.), Royal Perth Hospital, the Department of Respiratory Medicine, Sir Charles Gairdner Hospital (Y.C.G.L.), and the Centre for Respiratory Health, School of Medicine and Pharmacology, University of Western Australia (Y.C.G.L.), Perth, Aeromedical and Retrieval Services, Ambulance Tasmania (S.G.A.B.), and the Department of Respiratory Medicine, Royal Hobart Hospital (E.L.B.), Hobart, the Emergency Department, St. George Hospital, Kogarah, NSW (S.E.A.), St. George Clinical School, Faculty of Medicine, University of New South Wales, Kensington (S.E.A., B.C.H.K.), the Emergency Department, Monash Medical Centre (D.E.-W.), the Departments of Medicine (D.E.-W.) and Surgery (J.A.S.), School of Clinical Sciences at Monash Health, Monash University, and the Department of Cardiothoracic Surgery, Monash Health (J.A.S.), Clayton, VIC, the Emergency Department, Gold Coast Health Service District, the School of Medicine, Bond University, and the School of Medicine, Griffith University, Gold Coast, QLD (G.K.), Emergency Medical and Children's Services, Prince Charles Hospital, Chermside, QLD (F.B.K.), the University of Queensland, Brisbane (F.B.K.), the Department of Respiratory and Sleep Medicine, Sutherland Hospital, Sydney (B.C.H.K.), and the Department of Respiratory Medicine, Cairns Hospital, Cairns, QLD (G.S.) - all in Australia; the Medical Research Institute of New Zealand (K.P., I.B., M.W., R.B.), the Capital and Coast District Health Board (K.P., M.W., R.B.), and Pacific Radiology (M.N.), Wellington, and the Adult Emergency Department, Auckland City Hospital and University of Auckland, Auckland (P.G.J.) - all in New Zealand
| | - Frances B Kinnear
- From the Centre for Clinical Research in Emergency Medicine, Harry Perkins Institute of Medical Research, Royal Perth Hospital, and the University of Western Australia (S.G.A.B., E.L.B., C.A.R.), Royal Perth Hospital Imaging (K.V.L.) and the Respiratory Department (E.L.B., Q.A.S.), Royal Perth Hospital, the Department of Respiratory Medicine, Sir Charles Gairdner Hospital (Y.C.G.L.), and the Centre for Respiratory Health, School of Medicine and Pharmacology, University of Western Australia (Y.C.G.L.), Perth, Aeromedical and Retrieval Services, Ambulance Tasmania (S.G.A.B.), and the Department of Respiratory Medicine, Royal Hobart Hospital (E.L.B.), Hobart, the Emergency Department, St. George Hospital, Kogarah, NSW (S.E.A.), St. George Clinical School, Faculty of Medicine, University of New South Wales, Kensington (S.E.A., B.C.H.K.), the Emergency Department, Monash Medical Centre (D.E.-W.), the Departments of Medicine (D.E.-W.) and Surgery (J.A.S.), School of Clinical Sciences at Monash Health, Monash University, and the Department of Cardiothoracic Surgery, Monash Health (J.A.S.), Clayton, VIC, the Emergency Department, Gold Coast Health Service District, the School of Medicine, Bond University, and the School of Medicine, Griffith University, Gold Coast, QLD (G.K.), Emergency Medical and Children's Services, Prince Charles Hospital, Chermside, QLD (F.B.K.), the University of Queensland, Brisbane (F.B.K.), the Department of Respiratory and Sleep Medicine, Sutherland Hospital, Sydney (B.C.H.K.), and the Department of Respiratory Medicine, Cairns Hospital, Cairns, QLD (G.S.) - all in Australia; the Medical Research Institute of New Zealand (K.P., I.B., M.W., R.B.), the Capital and Coast District Health Board (K.P., M.W., R.B.), and Pacific Radiology (M.N.), Wellington, and the Adult Emergency Department, Auckland City Hospital and University of Auckland, Auckland (P.G.J.) - all in New Zealand
| | - Ben C H Kwan
- From the Centre for Clinical Research in Emergency Medicine, Harry Perkins Institute of Medical Research, Royal Perth Hospital, and the University of Western Australia (S.G.A.B., E.L.B., C.A.R.), Royal Perth Hospital Imaging (K.V.L.) and the Respiratory Department (E.L.B., Q.A.S.), Royal Perth Hospital, the Department of Respiratory Medicine, Sir Charles Gairdner Hospital (Y.C.G.L.), and the Centre for Respiratory Health, School of Medicine and Pharmacology, University of Western Australia (Y.C.G.L.), Perth, Aeromedical and Retrieval Services, Ambulance Tasmania (S.G.A.B.), and the Department of Respiratory Medicine, Royal Hobart Hospital (E.L.B.), Hobart, the Emergency Department, St. George Hospital, Kogarah, NSW (S.E.A.), St. George Clinical School, Faculty of Medicine, University of New South Wales, Kensington (S.E.A., B.C.H.K.), the Emergency Department, Monash Medical Centre (D.E.-W.), the Departments of Medicine (D.E.-W.) and Surgery (J.A.S.), School of Clinical Sciences at Monash Health, Monash University, and the Department of Cardiothoracic Surgery, Monash Health (J.A.S.), Clayton, VIC, the Emergency Department, Gold Coast Health Service District, the School of Medicine, Bond University, and the School of Medicine, Griffith University, Gold Coast, QLD (G.K.), Emergency Medical and Children's Services, Prince Charles Hospital, Chermside, QLD (F.B.K.), the University of Queensland, Brisbane (F.B.K.), the Department of Respiratory and Sleep Medicine, Sutherland Hospital, Sydney (B.C.H.K.), and the Department of Respiratory Medicine, Cairns Hospital, Cairns, QLD (G.S.) - all in Australia; the Medical Research Institute of New Zealand (K.P., I.B., M.W., R.B.), the Capital and Coast District Health Board (K.P., M.W., R.B.), and Pacific Radiology (M.N.), Wellington, and the Adult Emergency Department, Auckland City Hospital and University of Auckland, Auckland (P.G.J.) - all in New Zealand
| | - K V Lam
- From the Centre for Clinical Research in Emergency Medicine, Harry Perkins Institute of Medical Research, Royal Perth Hospital, and the University of Western Australia (S.G.A.B., E.L.B., C.A.R.), Royal Perth Hospital Imaging (K.V.L.) and the Respiratory Department (E.L.B., Q.A.S.), Royal Perth Hospital, the Department of Respiratory Medicine, Sir Charles Gairdner Hospital (Y.C.G.L.), and the Centre for Respiratory Health, School of Medicine and Pharmacology, University of Western Australia (Y.C.G.L.), Perth, Aeromedical and Retrieval Services, Ambulance Tasmania (S.G.A.B.), and the Department of Respiratory Medicine, Royal Hobart Hospital (E.L.B.), Hobart, the Emergency Department, St. George Hospital, Kogarah, NSW (S.E.A.), St. George Clinical School, Faculty of Medicine, University of New South Wales, Kensington (S.E.A., B.C.H.K.), the Emergency Department, Monash Medical Centre (D.E.-W.), the Departments of Medicine (D.E.-W.) and Surgery (J.A.S.), School of Clinical Sciences at Monash Health, Monash University, and the Department of Cardiothoracic Surgery, Monash Health (J.A.S.), Clayton, VIC, the Emergency Department, Gold Coast Health Service District, the School of Medicine, Bond University, and the School of Medicine, Griffith University, Gold Coast, QLD (G.K.), Emergency Medical and Children's Services, Prince Charles Hospital, Chermside, QLD (F.B.K.), the University of Queensland, Brisbane (F.B.K.), the Department of Respiratory and Sleep Medicine, Sutherland Hospital, Sydney (B.C.H.K.), and the Department of Respiratory Medicine, Cairns Hospital, Cairns, QLD (G.S.) - all in Australia; the Medical Research Institute of New Zealand (K.P., I.B., M.W., R.B.), the Capital and Coast District Health Board (K.P., M.W., R.B.), and Pacific Radiology (M.N.), Wellington, and the Adult Emergency Department, Auckland City Hospital and University of Auckland, Auckland (P.G.J.) - all in New Zealand
| | - Y C Gary Lee
- From the Centre for Clinical Research in Emergency Medicine, Harry Perkins Institute of Medical Research, Royal Perth Hospital, and the University of Western Australia (S.G.A.B., E.L.B., C.A.R.), Royal Perth Hospital Imaging (K.V.L.) and the Respiratory Department (E.L.B., Q.A.S.), Royal Perth Hospital, the Department of Respiratory Medicine, Sir Charles Gairdner Hospital (Y.C.G.L.), and the Centre for Respiratory Health, School of Medicine and Pharmacology, University of Western Australia (Y.C.G.L.), Perth, Aeromedical and Retrieval Services, Ambulance Tasmania (S.G.A.B.), and the Department of Respiratory Medicine, Royal Hobart Hospital (E.L.B.), Hobart, the Emergency Department, St. George Hospital, Kogarah, NSW (S.E.A.), St. George Clinical School, Faculty of Medicine, University of New South Wales, Kensington (S.E.A., B.C.H.K.), the Emergency Department, Monash Medical Centre (D.E.-W.), the Departments of Medicine (D.E.-W.) and Surgery (J.A.S.), School of Clinical Sciences at Monash Health, Monash University, and the Department of Cardiothoracic Surgery, Monash Health (J.A.S.), Clayton, VIC, the Emergency Department, Gold Coast Health Service District, the School of Medicine, Bond University, and the School of Medicine, Griffith University, Gold Coast, QLD (G.K.), Emergency Medical and Children's Services, Prince Charles Hospital, Chermside, QLD (F.B.K.), the University of Queensland, Brisbane (F.B.K.), the Department of Respiratory and Sleep Medicine, Sutherland Hospital, Sydney (B.C.H.K.), and the Department of Respiratory Medicine, Cairns Hospital, Cairns, QLD (G.S.) - all in Australia; the Medical Research Institute of New Zealand (K.P., I.B., M.W., R.B.), the Capital and Coast District Health Board (K.P., M.W., R.B.), and Pacific Radiology (M.N.), Wellington, and the Adult Emergency Department, Auckland City Hospital and University of Auckland, Auckland (P.G.J.) - all in New Zealand
| | - Mike Nowitz
- From the Centre for Clinical Research in Emergency Medicine, Harry Perkins Institute of Medical Research, Royal Perth Hospital, and the University of Western Australia (S.G.A.B., E.L.B., C.A.R.), Royal Perth Hospital Imaging (K.V.L.) and the Respiratory Department (E.L.B., Q.A.S.), Royal Perth Hospital, the Department of Respiratory Medicine, Sir Charles Gairdner Hospital (Y.C.G.L.), and the Centre for Respiratory Health, School of Medicine and Pharmacology, University of Western Australia (Y.C.G.L.), Perth, Aeromedical and Retrieval Services, Ambulance Tasmania (S.G.A.B.), and the Department of Respiratory Medicine, Royal Hobart Hospital (E.L.B.), Hobart, the Emergency Department, St. George Hospital, Kogarah, NSW (S.E.A.), St. George Clinical School, Faculty of Medicine, University of New South Wales, Kensington (S.E.A., B.C.H.K.), the Emergency Department, Monash Medical Centre (D.E.-W.), the Departments of Medicine (D.E.-W.) and Surgery (J.A.S.), School of Clinical Sciences at Monash Health, Monash University, and the Department of Cardiothoracic Surgery, Monash Health (J.A.S.), Clayton, VIC, the Emergency Department, Gold Coast Health Service District, the School of Medicine, Bond University, and the School of Medicine, Griffith University, Gold Coast, QLD (G.K.), Emergency Medical and Children's Services, Prince Charles Hospital, Chermside, QLD (F.B.K.), the University of Queensland, Brisbane (F.B.K.), the Department of Respiratory and Sleep Medicine, Sutherland Hospital, Sydney (B.C.H.K.), and the Department of Respiratory Medicine, Cairns Hospital, Cairns, QLD (G.S.) - all in Australia; the Medical Research Institute of New Zealand (K.P., I.B., M.W., R.B.), the Capital and Coast District Health Board (K.P., M.W., R.B.), and Pacific Radiology (M.N.), Wellington, and the Adult Emergency Department, Auckland City Hospital and University of Auckland, Auckland (P.G.J.) - all in New Zealand
| | - Catherine A Read
- From the Centre for Clinical Research in Emergency Medicine, Harry Perkins Institute of Medical Research, Royal Perth Hospital, and the University of Western Australia (S.G.A.B., E.L.B., C.A.R.), Royal Perth Hospital Imaging (K.V.L.) and the Respiratory Department (E.L.B., Q.A.S.), Royal Perth Hospital, the Department of Respiratory Medicine, Sir Charles Gairdner Hospital (Y.C.G.L.), and the Centre for Respiratory Health, School of Medicine and Pharmacology, University of Western Australia (Y.C.G.L.), Perth, Aeromedical and Retrieval Services, Ambulance Tasmania (S.G.A.B.), and the Department of Respiratory Medicine, Royal Hobart Hospital (E.L.B.), Hobart, the Emergency Department, St. George Hospital, Kogarah, NSW (S.E.A.), St. George Clinical School, Faculty of Medicine, University of New South Wales, Kensington (S.E.A., B.C.H.K.), the Emergency Department, Monash Medical Centre (D.E.-W.), the Departments of Medicine (D.E.-W.) and Surgery (J.A.S.), School of Clinical Sciences at Monash Health, Monash University, and the Department of Cardiothoracic Surgery, Monash Health (J.A.S.), Clayton, VIC, the Emergency Department, Gold Coast Health Service District, the School of Medicine, Bond University, and the School of Medicine, Griffith University, Gold Coast, QLD (G.K.), Emergency Medical and Children's Services, Prince Charles Hospital, Chermside, QLD (F.B.K.), the University of Queensland, Brisbane (F.B.K.), the Department of Respiratory and Sleep Medicine, Sutherland Hospital, Sydney (B.C.H.K.), and the Department of Respiratory Medicine, Cairns Hospital, Cairns, QLD (G.S.) - all in Australia; the Medical Research Institute of New Zealand (K.P., I.B., M.W., R.B.), the Capital and Coast District Health Board (K.P., M.W., R.B.), and Pacific Radiology (M.N.), Wellington, and the Adult Emergency Department, Auckland City Hospital and University of Auckland, Auckland (P.G.J.) - all in New Zealand
| | - Graham Simpson
- From the Centre for Clinical Research in Emergency Medicine, Harry Perkins Institute of Medical Research, Royal Perth Hospital, and the University of Western Australia (S.G.A.B., E.L.B., C.A.R.), Royal Perth Hospital Imaging (K.V.L.) and the Respiratory Department (E.L.B., Q.A.S.), Royal Perth Hospital, the Department of Respiratory Medicine, Sir Charles Gairdner Hospital (Y.C.G.L.), and the Centre for Respiratory Health, School of Medicine and Pharmacology, University of Western Australia (Y.C.G.L.), Perth, Aeromedical and Retrieval Services, Ambulance Tasmania (S.G.A.B.), and the Department of Respiratory Medicine, Royal Hobart Hospital (E.L.B.), Hobart, the Emergency Department, St. George Hospital, Kogarah, NSW (S.E.A.), St. George Clinical School, Faculty of Medicine, University of New South Wales, Kensington (S.E.A., B.C.H.K.), the Emergency Department, Monash Medical Centre (D.E.-W.), the Departments of Medicine (D.E.-W.) and Surgery (J.A.S.), School of Clinical Sciences at Monash Health, Monash University, and the Department of Cardiothoracic Surgery, Monash Health (J.A.S.), Clayton, VIC, the Emergency Department, Gold Coast Health Service District, the School of Medicine, Bond University, and the School of Medicine, Griffith University, Gold Coast, QLD (G.K.), Emergency Medical and Children's Services, Prince Charles Hospital, Chermside, QLD (F.B.K.), the University of Queensland, Brisbane (F.B.K.), the Department of Respiratory and Sleep Medicine, Sutherland Hospital, Sydney (B.C.H.K.), and the Department of Respiratory Medicine, Cairns Hospital, Cairns, QLD (G.S.) - all in Australia; the Medical Research Institute of New Zealand (K.P., I.B., M.W., R.B.), the Capital and Coast District Health Board (K.P., M.W., R.B.), and Pacific Radiology (M.N.), Wellington, and the Adult Emergency Department, Auckland City Hospital and University of Auckland, Auckland (P.G.J.) - all in New Zealand
| | - Julian A Smith
- From the Centre for Clinical Research in Emergency Medicine, Harry Perkins Institute of Medical Research, Royal Perth Hospital, and the University of Western Australia (S.G.A.B., E.L.B., C.A.R.), Royal Perth Hospital Imaging (K.V.L.) and the Respiratory Department (E.L.B., Q.A.S.), Royal Perth Hospital, the Department of Respiratory Medicine, Sir Charles Gairdner Hospital (Y.C.G.L.), and the Centre for Respiratory Health, School of Medicine and Pharmacology, University of Western Australia (Y.C.G.L.), Perth, Aeromedical and Retrieval Services, Ambulance Tasmania (S.G.A.B.), and the Department of Respiratory Medicine, Royal Hobart Hospital (E.L.B.), Hobart, the Emergency Department, St. George Hospital, Kogarah, NSW (S.E.A.), St. George Clinical School, Faculty of Medicine, University of New South Wales, Kensington (S.E.A., B.C.H.K.), the Emergency Department, Monash Medical Centre (D.E.-W.), the Departments of Medicine (D.E.-W.) and Surgery (J.A.S.), School of Clinical Sciences at Monash Health, Monash University, and the Department of Cardiothoracic Surgery, Monash Health (J.A.S.), Clayton, VIC, the Emergency Department, Gold Coast Health Service District, the School of Medicine, Bond University, and the School of Medicine, Griffith University, Gold Coast, QLD (G.K.), Emergency Medical and Children's Services, Prince Charles Hospital, Chermside, QLD (F.B.K.), the University of Queensland, Brisbane (F.B.K.), the Department of Respiratory and Sleep Medicine, Sutherland Hospital, Sydney (B.C.H.K.), and the Department of Respiratory Medicine, Cairns Hospital, Cairns, QLD (G.S.) - all in Australia; the Medical Research Institute of New Zealand (K.P., I.B., M.W., R.B.), the Capital and Coast District Health Board (K.P., M.W., R.B.), and Pacific Radiology (M.N.), Wellington, and the Adult Emergency Department, Auckland City Hospital and University of Auckland, Auckland (P.G.J.) - all in New Zealand
| | - Quentin A Summers
- From the Centre for Clinical Research in Emergency Medicine, Harry Perkins Institute of Medical Research, Royal Perth Hospital, and the University of Western Australia (S.G.A.B., E.L.B., C.A.R.), Royal Perth Hospital Imaging (K.V.L.) and the Respiratory Department (E.L.B., Q.A.S.), Royal Perth Hospital, the Department of Respiratory Medicine, Sir Charles Gairdner Hospital (Y.C.G.L.), and the Centre for Respiratory Health, School of Medicine and Pharmacology, University of Western Australia (Y.C.G.L.), Perth, Aeromedical and Retrieval Services, Ambulance Tasmania (S.G.A.B.), and the Department of Respiratory Medicine, Royal Hobart Hospital (E.L.B.), Hobart, the Emergency Department, St. George Hospital, Kogarah, NSW (S.E.A.), St. George Clinical School, Faculty of Medicine, University of New South Wales, Kensington (S.E.A., B.C.H.K.), the Emergency Department, Monash Medical Centre (D.E.-W.), the Departments of Medicine (D.E.-W.) and Surgery (J.A.S.), School of Clinical Sciences at Monash Health, Monash University, and the Department of Cardiothoracic Surgery, Monash Health (J.A.S.), Clayton, VIC, the Emergency Department, Gold Coast Health Service District, the School of Medicine, Bond University, and the School of Medicine, Griffith University, Gold Coast, QLD (G.K.), Emergency Medical and Children's Services, Prince Charles Hospital, Chermside, QLD (F.B.K.), the University of Queensland, Brisbane (F.B.K.), the Department of Respiratory and Sleep Medicine, Sutherland Hospital, Sydney (B.C.H.K.), and the Department of Respiratory Medicine, Cairns Hospital, Cairns, QLD (G.S.) - all in Australia; the Medical Research Institute of New Zealand (K.P., I.B., M.W., R.B.), the Capital and Coast District Health Board (K.P., M.W., R.B.), and Pacific Radiology (M.N.), Wellington, and the Adult Emergency Department, Auckland City Hospital and University of Auckland, Auckland (P.G.J.) - all in New Zealand
| | - Mark Weatherall
- From the Centre for Clinical Research in Emergency Medicine, Harry Perkins Institute of Medical Research, Royal Perth Hospital, and the University of Western Australia (S.G.A.B., E.L.B., C.A.R.), Royal Perth Hospital Imaging (K.V.L.) and the Respiratory Department (E.L.B., Q.A.S.), Royal Perth Hospital, the Department of Respiratory Medicine, Sir Charles Gairdner Hospital (Y.C.G.L.), and the Centre for Respiratory Health, School of Medicine and Pharmacology, University of Western Australia (Y.C.G.L.), Perth, Aeromedical and Retrieval Services, Ambulance Tasmania (S.G.A.B.), and the Department of Respiratory Medicine, Royal Hobart Hospital (E.L.B.), Hobart, the Emergency Department, St. George Hospital, Kogarah, NSW (S.E.A.), St. George Clinical School, Faculty of Medicine, University of New South Wales, Kensington (S.E.A., B.C.H.K.), the Emergency Department, Monash Medical Centre (D.E.-W.), the Departments of Medicine (D.E.-W.) and Surgery (J.A.S.), School of Clinical Sciences at Monash Health, Monash University, and the Department of Cardiothoracic Surgery, Monash Health (J.A.S.), Clayton, VIC, the Emergency Department, Gold Coast Health Service District, the School of Medicine, Bond University, and the School of Medicine, Griffith University, Gold Coast, QLD (G.K.), Emergency Medical and Children's Services, Prince Charles Hospital, Chermside, QLD (F.B.K.), the University of Queensland, Brisbane (F.B.K.), the Department of Respiratory and Sleep Medicine, Sutherland Hospital, Sydney (B.C.H.K.), and the Department of Respiratory Medicine, Cairns Hospital, Cairns, QLD (G.S.) - all in Australia; the Medical Research Institute of New Zealand (K.P., I.B., M.W., R.B.), the Capital and Coast District Health Board (K.P., M.W., R.B.), and Pacific Radiology (M.N.), Wellington, and the Adult Emergency Department, Auckland City Hospital and University of Auckland, Auckland (P.G.J.) - all in New Zealand
| | - Richard Beasley
- From the Centre for Clinical Research in Emergency Medicine, Harry Perkins Institute of Medical Research, Royal Perth Hospital, and the University of Western Australia (S.G.A.B., E.L.B., C.A.R.), Royal Perth Hospital Imaging (K.V.L.) and the Respiratory Department (E.L.B., Q.A.S.), Royal Perth Hospital, the Department of Respiratory Medicine, Sir Charles Gairdner Hospital (Y.C.G.L.), and the Centre for Respiratory Health, School of Medicine and Pharmacology, University of Western Australia (Y.C.G.L.), Perth, Aeromedical and Retrieval Services, Ambulance Tasmania (S.G.A.B.), and the Department of Respiratory Medicine, Royal Hobart Hospital (E.L.B.), Hobart, the Emergency Department, St. George Hospital, Kogarah, NSW (S.E.A.), St. George Clinical School, Faculty of Medicine, University of New South Wales, Kensington (S.E.A., B.C.H.K.), the Emergency Department, Monash Medical Centre (D.E.-W.), the Departments of Medicine (D.E.-W.) and Surgery (J.A.S.), School of Clinical Sciences at Monash Health, Monash University, and the Department of Cardiothoracic Surgery, Monash Health (J.A.S.), Clayton, VIC, the Emergency Department, Gold Coast Health Service District, the School of Medicine, Bond University, and the School of Medicine, Griffith University, Gold Coast, QLD (G.K.), Emergency Medical and Children's Services, Prince Charles Hospital, Chermside, QLD (F.B.K.), the University of Queensland, Brisbane (F.B.K.), the Department of Respiratory and Sleep Medicine, Sutherland Hospital, Sydney (B.C.H.K.), and the Department of Respiratory Medicine, Cairns Hospital, Cairns, QLD (G.S.) - all in Australia; the Medical Research Institute of New Zealand (K.P., I.B., M.W., R.B.), the Capital and Coast District Health Board (K.P., M.W., R.B.), and Pacific Radiology (M.N.), Wellington, and the Adult Emergency Department, Auckland City Hospital and University of Auckland, Auckland (P.G.J.) - all in New Zealand
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Tan J, Chen H, He J, Zhao L. Needle Aspiration Versus Closed Thoracostomy in the Treatment of Spontaneous Pneumothorax: A Meta-analysis. Lung 2020; 198:333-344. [PMID: 31927656 DOI: 10.1007/s00408-020-00322-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Accepted: 01/03/2020] [Indexed: 12/28/2022]
Abstract
PURPOSE To compare the effectiveness and safety between needle aspiration (NA) and closed thoracostomy (CT) method in adult spontaneous pneumothorax (SP) patients and to explore the most effective and safe protocol by using meta-analysis method. MATERIALS AND METHODS This study was based on Cochrane methodology for conducting meta-analysis. Only randomized controlled trials were eligible for this study. The participants were adults who had SP. The Review Manager Database was used to analyze selected studies. RESULTS Nine RCTs involving 665 patients were included. Although the initial success rate of CT was higher, the two groups were not statistically significant (RR 0.87 [95% CI 0.76-1.00]; p = 0.05). Compared the NA group, the use of CT method to treat SP significantly increased complications (RR 0.17 [95% CI 0.06-0.45]; p = 0.0003) and operation rate (RR 0.57 [95% CI 0.35-0.95]; p = 0.03). There was no significant difference in the 1-week success rate, admitted rate, 3-month recurrence rate, 1-year recurrence rate, and recurrence time between the two groups. Subgroup analysis of primary spontaneous pneumothorax (PSP) and secondary spontaneous pneumothorax (SSP) patients showed that the initial success rate of the CT method was higher than NA group (RR 0.74 [95% CI 0.60-0.92]; p = 0.007). CONCLUSIONS For the treatment of SP, NA method could significantly decrease complication rate, operation rate, as well as hospital stay length, compared with the CT method. Subgroup analysis indicated that the use of CT method in SSP and PSP patients might increase the initial success rate.
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Affiliation(s)
- Jixiang Tan
- Department of Emergency & Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Hong Chen
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jin He
- Department of Nephrology, Chonggang General Hospital, Chongqing, China
| | - Lin Zhao
- Department of Emergency & Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China.
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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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Domokos D, Szabo A, Banhegyi G, Polgar B, Bari Z, Bogyi P, Marczell I, Papp L, Kiss RG, Duray GZ, Merkely B, Hizoh I. Needle aspiration for treating iatrogenic pneumothorax after cardiac electronic device implantation: a pilot study. J Interv Card Electrophysiol 2019; 57:295-301. [PMID: 31342222 PMCID: PMC7093351 DOI: 10.1007/s10840-019-00596-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 07/15/2019] [Indexed: 11/21/2022]
Abstract
Purpose Pneumothorax (PTX) following cardiac implantable electronic device procedures is traditionally treated with chest tube drainage (CTD). We hypothesized that, in a subset of patients, the less invasive needle aspiration (NA) may also be effective. We compared the strategy of primary NA with that of primary CTD in a single-center observational study. Methods Of the 970 procedures with subclavian venous access between January 2016 and June 2018, 23 patients had PTX requiring intervention. Beginning with March 2017, the traditional primary CTD (9 cases) has been replaced by the “NA first” strategy (14 patients). Outcome measures were procedural success rate and duration of hospitalization evaluated both as time to event (log-rank test) and as a discrete variable (Wilcoxon-Mann-Whitney test). Results Needle aspiration was successful in 8/14 (57.1%) of the cases (95% CI 28.9–82.3%), whereas PTX resolved in all patients after CTD was 9/9 (100%, 95% CI 66.4–100.0%, p = 0.0481). Regarding length of hospital stay, intention to treat time to event analysis showed no difference between the two approaches (p = 0.73). Also, the median difference was not statistically significant (− 2.0 days, p = 0.17). In contrast, per protocol evaluation revealed reduced risk of prolonged hospitalization for NA patients (p = 0.0025) with a median difference of − 4.0 days (p = 0.0012). Failure of NA did not result in a meaningful delay in discharge timing as median difference was 1.5 days (p = 0.28). Conclusions Our data suggest that in a number of patients iatrogenic PTX may be successfully treated with NA resulting in shorter hospitalization without the risk of meaningful discharge delay in unsuccessful cases.
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Affiliation(s)
- Dominika Domokos
- Heart and Vascular Center, Semmelweis University, Budapest, 1122, Hungary
| | - Andras Szabo
- Department of Anesthesiology and Intensive Care, Semmelweis University, Budapest, Hungary
| | | | - Balazs Polgar
- Department of Cardiology, Medical Center Hungarian Defense Forces, Budapest, Hungary
| | - Zsolt Bari
- Department of Cardiology, Medical Center Hungarian Defense Forces, Budapest, Hungary
| | - Peter Bogyi
- Department of Cardiology, Medical Center Hungarian Defense Forces, Budapest, Hungary
| | - Istvan Marczell
- Department of Cardiology, Medical Center Hungarian Defense Forces, Budapest, Hungary
| | - Leticia Papp
- Department of Cardiology, Medical Center Hungarian Defense Forces, Budapest, Hungary
| | - Robert Gabor Kiss
- Department of Cardiology, Medical Center Hungarian Defense Forces, Budapest, Hungary
| | - Gabor Zoltan Duray
- Department of Cardiology, Medical Center Hungarian Defense Forces, Budapest, Hungary
| | - Bela Merkely
- Heart and Vascular Center, Semmelweis University, Budapest, 1122, Hungary
| | - Istvan Hizoh
- Heart and Vascular Center, Semmelweis University, Budapest, 1122, Hungary.
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Vuillard C, Dib F, Achamlal J, Gaudry S, Roux D, Chemouny M, Javaud N, Dreyfuss D, Ricard JD, Messika J. Longer symptom onset to aspiration time predicts success of needle aspiration in primary spontaneous pneumothorax. Thorax 2019; 74:780-786. [DOI: 10.1136/thoraxjnl-2019-213168] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 05/22/2019] [Accepted: 05/26/2019] [Indexed: 11/04/2022]
Abstract
BackgroundNeedle aspiration (NA) is recommended as first-line treatment of primary spontaneous pneumothorax (PSP). We aimed to assess NA success and the effect of a longer symptom onset to NA time.MethodsA discovery phase was retrospectively conducted in the intensive care unit of Louis Mourier Hospital (January 2000 to December 2011) followed by a prospective validation cohort (January 2012 to August 2015). The primary outcome was immediate NA success defined by the absence of need for chest tube insertion within 24 hours of the procedure.ResultsIn the discovery phase, 130 patients were admitted for PSP and 98 had NA as first-line treatment (75%). The immediate success rate of NA was 34.7% and was higher when it was performed ≥48 hours after symptom onset (57.7% vs 25%; p=0.004). In the prospective cohort, 87 patients were admitted for PSP; 71 (82%) had NA as first-step treatment. The immediate success rate was 40.8%. NA was more successful when it was performed after 48 hours of symptoms’ onset (34.5% vs 7.1%; p=0.005). A delay between the first symptom and NA procedure ≥48 hours was associated with a higher success of NA (OR=13.54; 95% CI 1.37 to 133). A smaller pneumothorax estimated by Light’s index was associated with NA success (OR=0.95; 95% CI 0.92 to 0.98). To what extent some of these pneumothoraces would have had a spontaneous resolution remains unknown.ConclusionWhen managing PSP with NA, a longer symptom onset to NA time was associated with NA success.Trial registration numberNCT02528734.
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Daemen JHT, Lozekoot PWJ, Maessen JG, Gronenschild MHM, Bootsma GP, Hulsewé KWE, Vissers YJL, de Loos ER. Chest tube drainage versus video-assisted thoracoscopic surgery for a first episode of primary spontaneous pneumothorax: a systematic review and meta-analysis. Eur J Cardiothorac Surg 2019; 56:819-829. [DOI: 10.1093/ejcts/ezz116] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 02/25/2019] [Accepted: 03/04/2019] [Indexed: 11/14/2022] Open
Abstract
Summary
Primary spontaneous pneumothorax affects up to 28 patients per 100 000 population yearly and is commonly resolved by chest tube drainage. However, drainage is also known to be associated with ipsilateral recurrence rates ranging from 25% to 43%. Preventive video-assisted thoracoscopic surgery (VATS) may be an effective alternative to diminish these recurrence rates and its associated morbidity. The aim of this study was to compare the efficacy of chest tube drainage and VATS as first line treatments of an initial episode of primary spontaneous pneumothorax. The MEDLINE, EMBASE, CENTRAL and Clinicaltrials.gov databases were searched through 16 September 2018. Data regarding the ipsilateral recurrence rate and the length of hospitalization were extracted and submitted to meta-analysis using the random-effects model and the I2 test for heterogeneity. Two randomized controlled trials and 2 observational studies were included, enrolling a total of 479 patients. Pairwise analysis demonstrated significantly reduced ipsilateral recurrence rates [odds ratio 0.15, 95% confidence interval (CI) 0.07–0.33; P < 0.00001] and length of hospitalization (standardized mean difference −2.19, 95% CI −4.34 to −0.04; P = 0.046) in favour of VATS. However, a significant level of heterogeneity was detected for the length of hospitalization (I2 = 97%; P < 0.00001). Subgroup analysis that stratified study design found no statistical differences regarding recurrence rate. In conclusion, VATS can be an effective and attractive alternative to standard chest tube drainage, with reduced ipsilateral recurrence rates and length of hospitalization. However, given the low quality of the majority of included studies, more well-designed randomized controlled trials are necessary to strengthen the current evidence.
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Affiliation(s)
- Jean H T Daemen
- Division of General Thoracic Surgery, Department of Surgery, Zuyderland Medical Centre, Heerlen, Netherlands
| | - Pieter W J Lozekoot
- Division of General Thoracic Surgery, Department of Surgery, Zuyderland Medical Centre, Heerlen, Netherlands
| | - Jos G Maessen
- Department of Cardiothoracic Surgery, Maastricht University Medical Centre, Maastricht, Netherlands
| | | | - Gerben P Bootsma
- Department of Pulmonology, Zuyderland Medical Centre, Heerlen, Netherlands
| | - Karel W E Hulsewé
- Division of General Thoracic Surgery, Department of Surgery, Zuyderland Medical Centre, Heerlen, Netherlands
| | - Yvonne J L Vissers
- Division of General Thoracic Surgery, Department of Surgery, Zuyderland Medical Centre, Heerlen, Netherlands
| | - Erik R de Loos
- Division of General Thoracic Surgery, Department of Surgery, Zuyderland Medical Centre, Heerlen, Netherlands
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46
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Kim IH, Kang DK, Min HK, Hwang YH. A Prospective Randomized Trial Comparing Manual Needle Aspiration to Closed Thoracostomy as an Initial Treatment for the First Episode of Primary Spontaneous Pneumothorax. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2019; 52:85-90. [PMID: 31089445 PMCID: PMC6493257 DOI: 10.5090/kjtcs.2019.52.2.85] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 11/07/2018] [Accepted: 11/12/2018] [Indexed: 12/27/2022]
Abstract
Background Variation exists in the initial treatment for the first episode of primary spontaneous pneumothorax (PSP), and no definitive consensus exists due to a lack of high-quality evidence. This study examined the outcomes of needle aspiration and closed thoracostomy in first episodes of PSP requiring intervention. Methods This study was a randomized, prospective, single-center trial conducted between December 2015 and August 2016. Patients of all ages with a documented first episode of PSP who were unilaterally affected, hemodynamically stable, and had a pneumothorax measuring over 25% in size were included. Patients with underlying lung disease, severe comorbidities, bilateral pneumothorax, tension pneumothorax, recurrent pneumothorax, traumatic pneumothorax, and pregnancy were excluded. Patients were randomly assigned to the needle aspiration or closed thoracostomy group using a random number table. Results Forty patients with a first episode of PSP were recruited, and 21 and 19 patients were included in the needle aspiration group and the closed thoracostomy group, respectively. The hospital stay of each group was 2.1±1.8 days and 5.4±3.6 days, respectively (p<0.01). However, no significant differences were found in the success rate of initial treatment or the 1-month and 1-year recurrence rates. Conclusion Needle aspiration is a favorable initial treatment in patients experiencing a first episode of PSP.
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Affiliation(s)
- In Ha Kim
- Department of Thoracic and Cardiovascular Surgery, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Do Kyun Kang
- Department of Thoracic and Cardiovascular Surgery, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Ho-Ki Min
- Department of Thoracic and Cardiovascular Surgery, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Youn-Ho Hwang
- Department of Thoracic and Cardiovascular Surgery, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
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47
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Marx T, Kepka S, Desmettre T. Techniques d’exsufflation d’un pneumothorax. ANNALES FRANCAISES DE MEDECINE D URGENCE 2019. [DOI: 10.3166/afmu-2019-0149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Les pneumothorax rencontrés aux urgences peuvent être d’origine spontanée ou traumatique. L’exsufflation est une méthode thérapeutique simple du pneumothorax spontané primitif. Cette technique consiste à réaliser une aspiration par l’intermédiaire d’un cathéter, sans que le matériel soit laissé en place. Elle permet une prise en charge ambulatoire du patient et répond à des enjeux de qualité des soins (efficacité, simplicité, sécurité) et d’économie de la santé (diminution de la durée et du taux d’hospitalisation). L’exsufflation peut être réalisée via différents dispositifs tout simples d’utilisation, par voie antérieure ou axillaire. L’exsufflation à l’aiguille avec des cathéters de perfusion intraveineux est peu recommandée devant le risque d’échec lié à une longueur de cathéter inadaptée à la morphologie du patient. Les usages de drains de faible calibre avec la méthode de Seldinger ou de kits dédiés de thoracentèse sont à privilégier. Les complications sont moindres comparées à la pose d’un drain thoracique. Il s’agit le plus souvent d’obstruction ou de déplacement du cathéter. L’exsufflation est également un geste de sauvetage à réaliser en urgence en cas de pneumothorax suffocant. La bonne maîtrise de l’une de ces techniques est donc indispensable dans le cadre de la formation et de la pratique en médecine d’urgence.
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Plojoux J, Froudarakis M, Janssens JP, Soccal PM, Tschopp JM. New insights and improved strategies for the management of primary spontaneous pneumothorax. CLINICAL RESPIRATORY JOURNAL 2019; 13:195-201. [PMID: 30615303 DOI: 10.1111/crj.12990] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 12/14/2018] [Accepted: 12/24/2018] [Indexed: 12/22/2022]
Abstract
The pathophysiology and management of primary spontaneous pneumothorax (PSP) are a subject of debate. Despite advances in the understanding of its etiopathogenesis and improvements in its management, implementation in clinical practice is suboptimal. In this manuscript, we review the recent literature with a focus on PSP pathophysiology and management. Blebs and emphysema-like changes (ELC) are thought to contribute to the pathophysiology of PSP but cannot explain all cases. Recent studies emphasize the role of a diffuse porosity of the visceral pleura. Others found a relationship between smoking, occurrence of a PSP and bronchiolitis, which could be the initial pathological process leading to ELC development. Recent or ongoing studies challenge the need to systematically remove air from the pleural cavity of stable patients, introducing conservative management as a valuable therapeutic option. Evidence is growing in favour of needle aspiration instead of chest tube insertion, when air evacuation is needed. In addition, ambulatory management is considered as a successful approach in meta-analyses and is under exploration in a large randomized study. Because of a high recurrence rate of PSP, the benefit of performing a pleurodesis at first occurrence is under evaluation with interesting but not generalizable results. Better identification of 'at risk patients' is needed to improve the investigation strategy. Finally, recent publications confirm the efficacy, security and cost-effectiveness of graded talc poudrage pleurodesis to prevent PSP recurrence. In conclusion, PSP pathophysiology and management are still under investigation. The results of recently published and ongoing studies should be more widely implemented in clinical practice.
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Affiliation(s)
- Jérôme Plojoux
- Division of Pneumology, University Hospitals of Geneva, Geneva, Switzerland
| | - Marios Froudarakis
- Department of Respiratory Medicine, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Jean-Paul Janssens
- Division of Pneumology, University Hospitals of Geneva, Geneva, Switzerland.,Faculty of Medicine, Geneva University, Geneva, Switzerland
| | - Paola M Soccal
- Division of Pneumology, University Hospitals of Geneva, Geneva, Switzerland.,Faculty of Medicine, Geneva University, Geneva, Switzerland
| | - Jean-Marie Tschopp
- Centre Valaisan de Pneumologie, Department of Internal Medicine, Montana, Switzerland
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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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50
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Aljehani YM, Almajid FM, Niaz RC, Elghoneimy YF. Management of Primary Spontaneous Pneumothorax: A Single-center Experience. SAUDI JOURNAL OF MEDICINE & MEDICAL SCIENCES 2019; 6:100-103. [PMID: 30787829 PMCID: PMC6196700 DOI: 10.4103/sjmms.sjmms_163_16] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: The prevalence of primary spontaneous pneumothorax is high in the Arab region. There is a lack of studies from the Eastern Province of Saudi Arabia highlighting the associated risk factors and demonstrating the effectiveness of surgical management. Objectives: To identify risk factors associated with primary spontaneous pneumothorax and to correlate the effectiveness of surgical management with the rate of disease recurrence. Subjects and Methods: This retrospective chart review included adult patients who presented with primary spontaneous pneumothorax and were managed at King Fahd Hospital of the University, Al-Khobar, Saudi Arabia, from January 1, 2005, to December 31, 2014. The results are presented as arithmetic mean for quantitative data, and chi-square test was used for statistical analysis. P ≤0.05 was considered statistically significant. Results: In total, 151 patients with primary spontaneous pneumothorax were included, with the majority being male (98.7%) and Saudis (88.7%). The mean age was 24 ± 6 years (range: 13–49 years), mean height 171 ± 8 cm (range: 144–193 cm) and mean body mass index 19.2 ± 3.8 kg/m2 (range: 13.3–39.0 kg/m2). About 62% of the patients were smokers. Ten patients had an ipsilateral recurrence of primary spontaneous pneumothorax after the first episode was successfully managed. Surgical exploration after the first episode itself was found to significantly reduce the recurrence rate. The study found that in the management of these patients, there was a shift from conventional open thoracotomy to the minimally invasive video-assisted thoracoscopic surgery method. Conclusions: The risk factors for primary spontaneous pneumothorax in this study were consistent with the current literature. Surgical exploration after the first episode of primary spontaneous pneumothorax significantly reduces the recurrence rate and there is a paradigm shift toward a less invasive surgical approach in managing these patients.
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Affiliation(s)
- Yasser Mahir Aljehani
- Division of Thoracic Surgery, Department of Surgery, College of Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Feras Mohammed Almajid
- Division of Thoracic Surgery, Department of Surgery, College of Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Rabia C Niaz
- Division of Thoracic Surgery, Department of Surgery, College of Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Yasser Farag Elghoneimy
- Division of Thoracic Surgery, Department of Surgery, College of Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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