Introduction Small, asymptomatic pneumothoraces may be managed as outpatients. Several studies show that small-bore catheters and Heimlich valves may be used in the treatment of pneumothoraces. A systematic review of the literature1 showed successful outpatient management of pneumothorax. Despite good evidence to support ambulatory approach, there has been slow development of this service across the UK. We wished to assess the number of potential primary spontaneous pneumothorax patients that could be managed as outpatients in a large teaching hospital.
Methods Hospital attendances of pneumothorax at a large teaching hospital between 2012–2015 were reviewed. Type of pneumothorax was characterised: primary spontaneous (PSP), secondary spontaneous (SSP), iatrogenic (IP) and traumatic/post-operative. The data for PSP was then correlated against the data retrieved from the systematic review of outpatient pneumothorax management.1
Results Total number of pneumothorax episodes were 877; PSP 266, SSP 229, IP 41 and traumatic/post-operative 341. Average length of stay (LOS) for all episodes of pneumothorax was 12.39 days. LOS for PSP was 6.9 days. Total number of hospital admissions for PSP (266/3 =) 88.7 patients/year. Extrapolated from systematic review1: Successful outpatient PSP management (88.7*78% =) 77.1 patients/year. Potential bed days saved for PSP: (77.1*6.9 =) 532 beds/year.
Conclusions Studies show both spontaneous and iatrogenic pneumothorax may be managed safely as outpatients. Dedicated pleural services will result in correct stratification of patients requiring appropriate interventions. Ambulatory chest drains could be used and inserted by professionals trained in their use.
Advantages to patients: reduced need for hospital admission, greater patient autonomy, improved patient experience, no need to carry chest drain bottle, reduced likelihood of accidental dislodgement of chest drain, reduced time to discharge.
Advantages to trust: admission avoidance, early discharge, reduced costs, reduced complications from chest drain insertions, reduced hospital associated complications, optimised patient care with increased patient satisfaction.
Although we would not advocate the use of ambulatory pneumothorax devices in trauma patients, there is scope to establish whether they can be used post procedural (e.g. pneumothorax following pacemaker insertion).
Brims FJ, Maskell NA. Ambulatory treatment in the management of pneumothorax: a systematic review of the literature. Thorax 2013;68(7):664–9.