Introduction There is no clear consensus on the management of Spontaneous pneumothorax. BTS recommends insertion of chest drain following failure of initial aspiration in large primary spontaneous pneumothorax (PSP) and in all patients with symptomatic/ large secondary spontaneous pneumothorax (SSP). These patients are usually admitted to hospital following chest drain insertion.
Objective To study the feasibility and safety of early discharge of spontaneous pneumothorax patients requiring chest drain on the ambulatory pathway with a Heimlich valve (pneumostat device).
Methods Patients were initially managed as per BTS guidelines. Patients who had a chest drain inserted were admitted until review by the respiratory team. All PSP patients and some SSP patients with good performance status (WHO scale 0–1) were eligible for the ambulatory pathway. Those with continuing air leak are fitted with a Heimlich valve and discharged home. They were reassessed every two days with a CXR on arrival in the ambulatory care unit. The chest drain was removed once the air leak stopped for at least 24 h.
Results 21 episodes of spontaneous pneumothorax in 18 patients (10 PSP and 8 SSP) were treated on the ambulatory pathway between May’13 and June’14. The healthcare usage of patients on ambulatory pathway is listed in the table. The pneumothorax resolved successfully in 82% (17 episodes). There were three recurrences requiring repeat management on the ambulatory pathway. A total of 10 patients were referred to the surgeon including four with continuing air leak and six due to recurrence. Patients with continuing air leak remained in the community until admission for thoracic surgery. Complications included pain in two patients and allergic reaction to the dressing used in one patient. The patient with allergic reaction had accidental dislodgement of chest drain during dressing change necessitating reinsertion of chest drain.
Conclusion It is feasible for most patients with large PSP and many patients with SSP to be managed on an ambulatory care pathway with a Heimlich valve until their pneumothorax heals or is definitively treated.
Fanny Voisin et al. Ambulatory management of spontaneous pneumothorax with pigtail catheters. http://dx.doi.org.10.1016/j.annemergmed.2013.12.017
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