Introduction To compare the effectiveness of ambulatory management of primary (PSP) and selected secondary spontaneous pneumothoraces (SSP)
Methods Large PSP and selected SSP patients (WHO performance score 0–1) aged between 16–80 presenting between May 2013 and January 2016, were deemed eligible for the ambulatory pathway. They were reassessed every two days with a chest x-ray in the ambulatory care unit. The patients with Pneumostat™ valve (Atrium Medical Corporation) were taught to check for air-leak every day. Patient outcomes and complications were recorded. Patients with tension, iatrogenic or traumatic pneumothorax were excluded from the study.
Primary outcome measure
Success rate at day 5 defined as sustained complete re-expansion of lung with no air leak.
Secondary Outcome measures
Number of days spent with the chest drain in situ.
Complications like drain falling out, drain blockage, Infection
Number of patients requiring surgical treatment due to persisting air leak.
Results A total of 110 patients were reviewed with spontaneous pneumothorax, of which 54 were managed on the ambulatory pathway. (Table 1) The pneumothorax resolved successfully in 77% of the primaries pneumothoraces and 67% of the secondaries, with an overall resolution of 72%. In the PSP, five patients (16.7%) went on to have surgery due to non-resolution. Of the 24 SSP, eight (33.3%) patients went on to have surgery due to non-resolution. Complications other than pain were minimal. The mean duration of drainage was 3.8 days in PSP and 5.9 days in SSP. This compares well with the median drainage of 6–8 days for inpatient management of PSP (BTS guidelines).1
Conclusion The success rate was 72% for all spontaneous pneumothorax patients managed almost exclusively as outpatients, which compares well with the 78% suggested in the meta-analysis by Brimms and Maskell.2 This study confirms that the use of chest drain with one-way valves in the ambulatory management of primary and selected secondary spontaneous pneumothoraces is safe with very few complications. This procedure clearly decreases the number of hospitalisation days and is thus cost saving.
Mcduff A. BTS pleural disease guidelines. Thorax 2010;65(Suppl II):ii1–ii76.
Brims FJ, Maskell NA. Ambulatory treatment in the management of pneumothorax: a systematic review of the literature. Thorax 2013;68(7):664–9.