Introduction and objectives A Heimlich Valve attached to an intercostal drain facilitates the ambulatory management of primary spontaneous pneumothorax (PSP) and in selected individuals permits outpatient care. We have 3 years of experience in doing this with Atrium’s Pneumostat device. We ascertained the safety and cost effectiveness of this ambulatory pathway.
Methods We conducted a retrospective evaluation of all patients presenting with a PSP from March 2013 to December 2014. Data was collected on management, length of stay (LOS) and complications. Outpatients with a Pneumostat are advised to attend the chest clinic 24 h after bubbling stops for review for drain removal, or earlier if any concerns. Medical bed days saved was calculated as time at home with the device in situ, as standard BTS care would require an inpatient stay with a drainage bottle.
Results 73 patients presented with a PSP. 34 patients required chest tube drainage, 24 of which were managed as an outpatient with a Pneumostat. The median LOS in the outpatient group was 1.0 day (IQR 0.0–2.0 days) vs 3.5 days (IQR 1.3–7.0 days) in the inpatient group. A total of 98 bed days were saved using the device. Based on a cost of £25.70 per Pneumostat and £312 per bed day, the overall saving was £29,959.20. Patients who required thoracic surgery were kept on the “inpatient waiting list” and could be admitted directly from home.
In the outpatient group, there was 1 drain site infection, 1 drain displacement and 1 patient failed to attend follow-up but returned a week later with a resolved pneumothorax.
Conclusion Pneumostat devices have recently been withdrawn from use in the United States by FDA decree. Although legal in the UK and supported by the MHRA, a Certificate of Medical Necessity is required to purchase the devices and there is no alternative “all-in-one” solution that attaches to a standard chest drain. Our data shows that this device is safe in uncomplicated PSP and confers significant financial savings. These benefits should not be overlooked and a consensus statement is required to ensure their continued use in the UK.