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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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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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Weerawardane TDS, Bürgisser N, Berner A, Coen M. Valsalva Manoeuvre-Induced Pneumothorax and Pneumomediastinum in a Covid-19 Patient with ARDS: An Unusual Mechanism for this Complication. Eur J Case Rep Intern Med 2024; 11:004217. [PMID: 38455690 PMCID: PMC10917400 DOI: 10.12890/2024_004217] [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: 11/18/2023] [Accepted: 12/05/2024] [Indexed: 03/09/2024] Open
Abstract
Background Until now, only a few cases of Valsalva-induced barotraumas (pneumothorax, pneumomediastinum and subcutaneous emphysema) have been described, and none of them among COVID-19 patients. Case description A man in his 50s was admitted for SARS-CoV-2-related acute respiratory distress syndrome (ARDS). Initial evolution was favourable with non-invasive ventilatory support, high-flow oxygen nasal cannula and the best supportive drugs available at the time. During the Valsalva manoeuvre while defecating, the patient reported sudden chest pain and showed a new acute hypoxemic respiratory failure due to a pneumothorax. It led to multiple complications (pulmonary embolism, haemoptysis, and cardiac arrest), and despite the best supportive care, led to the patient's death. Discussion The Valsalva manoeuvre can be an overlooked cause of pneumothorax in patients with COVID-19. Predisposition to barotrauma in COVID-19 patients could be explained by several factors, including the extensive use of non-invasive and invasive ventilation during the pandemic, and the histological changes observed in the lungs of those infected with COVID-19. Conclusion We report the first description of a Valsalva-induced barotrauma in a COVID-19 infection. We emphasise the importance of treating constipation particularly in severe COVID-19 cases, to prevent complications such as barotrauma. LEARNING POINTS Pneumothorax is a common complication of severe COVID-19 infection, but Valsalva manoeuvre-induced pneumothorax in COVID-19 patients has never been reported previously.Particular care should be taken to prevent and treat constipation in hospitalised patients as it may cause a wide range of complications, including barotraumatism.The extensive use of non-invasive and invasive ventilation may play a role in barotrauma, but causal association has not been proven.
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Affiliation(s)
- Totawatte Don Srilak Weerawardane
- Division of General Internal Medicine, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland
- Unit of Development and Research in Medical Education (UDREM), University of Geneva, Geneva, Switzerland
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Nils Bürgisser
- Division of General Internal Medicine, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Amandine Berner
- Division of General Internal Medicine, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Matteo Coen
- Division of General Internal Medicine, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland
- Unit of Development and Research in Medical Education (UDREM), University of Geneva, Geneva, Switzerland
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Mazenq J, Dubus JC. [Diagnosis and management of idiopathic spontaneous pneumothorax in adolescents]. Rev Mal Respir 2024; 41:139-144. [PMID: 38326190 DOI: 10.1016/j.rmr.2023.12.002] [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: 10/08/2023] [Accepted: 11/11/2023] [Indexed: 02/09/2024]
Abstract
INTRODUCTION Due to the absence of consensual definition and agreed-upon pediatric treatment, pneumothorax (PNO) in children and adolescents often remains difficult to properly apprehend. STATE OF THE ART While initial diagnostic suspicion is clinical, confirmation necessitates chest imaging, and lung ultrasound has become increasingly prevalent, often at the expense of chest radiography. The goal of treatment is twofold, on the one hand to a fully re-expand the lungs, and on the other hand to forestall PNO recurrence. Depending on PNO severity and clinical tolerance, it may be advisable to envision conservative management, oxygen supplementation, needle exsufflation, or chest tube drainage. PERSPECTIVES In order to harmonize clinical practices, guidelines for the precise definition and graduated management of PNO in children and adolescents are highly advisable. CONCLUSIONS Idiopathic spontaneous PNO frequently occurs in teenage populations, and its likewise frequent recurrence is not satisfactorily predicted by chest CT findings. It is of paramount importance that patients be fully informed of the risk of recurrence.
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Affiliation(s)
- J Mazenq
- Service de pneumologie et allergologie pédiatrique, CHU Timone enfants - Assistance Publique des Hôpitaux de Marseille, Marseille, France; Aix-Marseille Université, Inserm, INRA, C2VN, Marseille, France.
| | - J-C Dubus
- Service de pneumologie et allergologie pédiatrique, CHU Timone enfants - Assistance Publique des Hôpitaux de Marseille, Marseille, France; RD, Aix Marseille Université, MEPHI, IHU Méditerranée Infection, Marseille, France
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5
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Meloy P, Bhambri A, Emeli IM. A Case Report of Spontaneous Pneumomediastinum From an Unusual Cause: Baritone Practice. Cureus 2023; 15:e47289. [PMID: 38021896 PMCID: PMC10656280 DOI: 10.7759/cureus.47289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2023] [Indexed: 12/01/2023] Open
Abstract
Spontaneous pneumomediastinum (SPM) is a rare but potentially life-threatening clinical entity in which free air is introduced into the mediastinum. It most commonly presents in young males and has an incidence of approximately 0.002% of the general population. Symptoms include sudden onset chest pain, dyspnea, neck pain, vomiting, and odynophagia. Physical examination usually reveals subcutaneous emphysema, hoarse voice, tachycardia, tachypnea, and occasionally a Hamman's sign, which is a mediastinal "crunch" sound heard on cardiac auscultation. We present a case of an 18-year-old male baritone player who presented to the ED with chest pain and odynophagia shortly after waking up one morning. The patient's chest radiograph (CXR) revealed free air in the mediastinum with subcutaneous air tracking into the soft tissues of the neck and supraclavicular region. CT of the chest with contrast esophagram confirmed the diagnosis of primary SPM. The cause of his condition was likely due to barotrauma secondary to playing the baritone in his marching band. He had no evidence of esophageal injury or infectious process which further supports the diagnosis of primary SPM. After an extensive workup, the patient was discharged from the ED with instructions on rest, analgesia, and antitussives as needed. Evaluation of chest pain patients in the ED should include a CXR, in addition to other indicated tests, to rule out this potentially debilitating condition. Fortunately, though SPM is potentially life-threatening, most cases resolve spontaneously without surgical intervention.
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Affiliation(s)
- Patrick Meloy
- Emergency Medicine, Emory University School of Medicine, Atlanta, USA
| | - Amit Bhambri
- Emergency Medicine, Swedish Hospital - Part of NorthShore University HealthSystem, Chicago, USA
| | - Iyesatta M Emeli
- Emergency Medicine, Emory University School of Medicine, Atlanta, USA
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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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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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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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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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Bezel P, Wani J, Wiederkehr G, Bodmer C, Steinack C, Franzen DP. Early Spirometry Following Bronchoscopic Lung Volume Reduction with Endobronchial Valves. J Clin Med 2022; 11:440. [PMID: 35054134 PMCID: PMC8780477 DOI: 10.3390/jcm11020440] [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: 11/14/2021] [Revised: 01/05/2022] [Accepted: 01/12/2022] [Indexed: 01/25/2023] Open
Abstract
Bronchoscopic lung volume reduction (BLVR) by endobronchial valve (EBV) implantation has been shown to improve dyspnea, pulmonary function, exercise capacity, and quality of life in highly selected patients with severe emphysema and hyperinflation. The most frequent adverse event is a pneumothorax (PTX), occurring in approximately one-fifth of the cases due to intrathoracic volume shifts. The majority of these incidents are observed within 48 h post-procedure. However, the delayed occurrence of PTX after hospital discharge is a matter of concern. There is currently no approved concept for its prevention. Particularly, it is unknown whether and when respiratory manoeuvers such as spirometry post EBV treatment are feasible and safe. As per standard operating procedure at the University Hospital Zurich, early spirometry is scheduled after BLVR and prior to the discharge of the patient in order to monitor treatment success. The aim of our retrospective study was to investigate the feasibility and safety of early spirometry. In addition, we hypothesized that early spirometry could be useful to identify patients at risk for late PTX, which may occur after hospital discharge. All patients who underwent BLVR using EBVs between January 2018 and January 2020 at our hospital were enrolled in this study. After excluding 16 patients diagnosed post-procedure with PTX and four patients for other reasons, early spirometry was performed in 61 cases. There was neither a clinically relevant PTX during or after early spirometry nor a late PTX following hospital discharge. In conclusion, we found early spirometry, conducted not sooner than three days following EBV treatment, to be feasible and safe. Furthermore, early spirometry seems to be a useful predictor for successful BLVR, and it may help to decide whether a patient can be discharged. Given the small sample size and the retrospective design of our study, a prospective study that includes routine chest imaging after early spirometry to definitively exclude PTX is needed to recommend early spirometry as part of the standard protocol following EBV treatment.
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Affiliation(s)
- Pascal Bezel
- Department of Pulmonology, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland; (P.B.); (G.W.); (C.B.); (C.S.); (D.P.F.)
| | - Jasmin Wani
- Department of Pulmonology, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland; (P.B.); (G.W.); (C.B.); (C.S.); (D.P.F.)
| | - Gilles Wiederkehr
- Department of Pulmonology, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland; (P.B.); (G.W.); (C.B.); (C.S.); (D.P.F.)
- Department of Pulmonology, Hirslanden Clinic St. Anna, St. Anna-Strasse 32, 6006 Luzern, Switzerland
| | - Christa Bodmer
- Department of Pulmonology, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland; (P.B.); (G.W.); (C.B.); (C.S.); (D.P.F.)
| | - Carolin Steinack
- Department of Pulmonology, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland; (P.B.); (G.W.); (C.B.); (C.S.); (D.P.F.)
| | - Daniel P. Franzen
- Department of Pulmonology, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland; (P.B.); (G.W.); (C.B.); (C.S.); (D.P.F.)
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Abstract
Pneumothorax is a common problem worldwide. Pneumothorax develops secondary to diverse aetiologies; in many cases, there may be no recognizable lung abnormality. The pathogenetic mechanism(s) causing spontaneous pneumothorax may be related to an interplay between lung-related abnormalities and environmental factors such as smoking. Tobacco smoking is a major risk factor for primary spontaneous pneumothorax; chronic obstructive pulmonary disease is most frequently associated with secondary spontaneous pneumothorax. This review article provides an overview of the historical perspective, epidemiology, classification, and aetiology of pneumothorax. It also aims to highlight current knowledge and understanding of underlying risks and pathophysiological mechanisms in pneumothorax development.
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Affiliation(s)
- Nai-Chien Huan
- Department of Pulmonology, Serdang Hospital, Kajang, Malaysia
| | - Calvin Sidhu
- Edith Cowan University, Perth, Australia; Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, Australia
| | - Rajesh Thomas
- Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, Australia; School of Medicine, University of Western Australia, Perth, Australia.
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Intraoperative Valsalva maneuver: a narrative review. Can J Anaesth 2018; 65:578-585. [PMID: 29368315 DOI: 10.1007/s12630-018-1074-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Revised: 12/08/2017] [Accepted: 12/20/2017] [Indexed: 01/10/2023] Open
Abstract
The Valsalva maneuver (VM) involves expiratory effort against a closed mouth and/or glottis in the sitting or supine position with the increased intraoral and intrathoracic pressure raised to 40 mmHg for 15-20 sec after which the pressure is suddenly released and the breathing restored to normal. Complex cardiovascular and other physiologic changes occur during the VM. The VM has been used for diagnostic and therapeutic reasons as well as intraoperatively during specific surgical procedures. Although the VM is usually safe, rare complications have been reported. This review examines the published literature surrounding the VM and explores the physiologic changes that occur during its performance. Attempts have been made to understand its intraoperative uses and complications and how these can be prevented.
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Herzog D, Poellinger A, Doellinger F, Schuermann D, Temmesfeld-Wollbrueck B, Froeling V, Schreiter NF, Neumann K, Hippenstiel S, Suttorp N, Hubner RH. Modifying Post-Operative Medical Care after EBV Implant May Reduce Pneumothorax Incidence. PLoS One 2015; 10:e0128097. [PMID: 26010886 PMCID: PMC4444119 DOI: 10.1371/journal.pone.0128097] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Accepted: 04/23/2015] [Indexed: 11/19/2022] Open
Abstract
Objective Endoscopic lung volume reduction (ELVR) with valves has been shown to improve COPD patients with severe emphysema. However, a major complication is pneumothoraces, occurring typically soon after valve implantation, with severe consequences if not managed promptly. Based on the knowledge that strain activity is related to a higher risk of pneumothoraces, we asked whether modifying post-operative medical care with the inclusion of strict short-term limitation of strain activity is associated with a lower incidence of pneumothorax. Methods Seventy-two (72) emphysematous patients without collateral ventilation were treated with bronchial valves and included in the study. Thirty-two (32) patients received standard post-implantation medical management (Standard Medical Care (SMC)), and 40 patients received a modified medical care that included an additional bed rest for 48 hours and cough suppression, as needed (Modified Medical Care (MMC)). Results The baseline characteristics were similar for the two groups, except there were more males in the SMC cohort. Overall, ten pneumothoraces occurred up to four days after ELVR, eight pneumothoraces in the SMC, and only two in the MMC cohorts (p=0.02). Complicated pneumothoraces and pneumothoraces after upper lobe treatment were significantly lower in MMC (p=0.02). Major clinical outcomes showed no significant differences between the two cohorts. Conclusions In conclusion, modifying post-operative medical care to include bed rest for 48 hours after ELVR and cough suppression, if needed, might reduce the incidence of pneumothoraces. Prospective randomized studies with larger numbers of well-matched patients are needed to confirm the data.
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Affiliation(s)
- Dominik Herzog
- Department of Internal Medicine/Infectious Diseases and Respiratory Medicine, Charité -Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Alexander Poellinger
- Institute of Radiology, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Felix Doellinger
- Institute of Radiology, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Dirk Schuermann
- Department of Internal Medicine/Infectious Diseases and Respiratory Medicine, Charité -Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Bettina Temmesfeld-Wollbrueck
- Department of Internal Medicine/Infectious Diseases and Respiratory Medicine, Charité -Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Vera Froeling
- Department of Nuclear Medicine, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13553, Berlin, Germany
| | - Nils F. Schreiter
- Institute of Radiology, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Konrad Neumann
- Institute for Biometry and Clinical Epidemiology, Charité -Universitätsmedizin Berlin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Stefan Hippenstiel
- Department of Internal Medicine/Infectious Diseases and Respiratory Medicine, Charité -Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Norbert Suttorp
- Department of Internal Medicine/Infectious Diseases and Respiratory Medicine, Charité -Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Ralf-Harto Hubner
- Department of Internal Medicine/Infectious Diseases and Respiratory Medicine, Charité -Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
- * E-mail:
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