Original Contribution
Pigtail catheters vs large-bore chest tubes for management of secondary spontaneous pneumothoraces in adults

https://doi.org/10.1016/j.ajem.2006.04.006Get rights and content

Abstract

It is still uncertain if large-bore chest tubes (20F-28F) is superior to pigtail catheter (10F-14F) in terms of the management of secondary spontaneous pneumothoraces (SSP).This study was designed to compare the efficacy and safety associated with placement of large-bore chest tubes vs pigtail catheters in adults experiencing the first episode of SSP. We conducted a retrospective chart review of 91 patients experiencing the first episode of SSP in a university hospital over a 3.5-year period who received treatment by either a large-bore chest tube or a pigtail catheter. Any patient who was younger than 18 years or experiencing mechanical ventilation–related barotraumas or pyopneumothorax was excluded from this study. Various parameters including demographical characteristics, size of pneumothorax, complications, time of pigtail or chest tube extubation, and length of hospital stay were collected and analyzed. Among the enrolled 91 patients, including 76 (83.5%) men with a mean age of 60 ± 19 years, 69 were initially treated with a pigtail, and 22 patients received conventional chest tubes. Fifty patients (72.5%) undergoing the pigtail drainage and 16 (72.7%) undergoing large-bore chest tube treatment of SSP were successfully treated (P = .88). In addition, there was no significant difference in terms of length of hospital stay, extubation time, recurrence rate, and complication. Pigtail catheters offer a safe and effective alternative for large-bore chest tubes to adult patients experiencing the first episode of SSP, and we strongly suggested that pigtail tube drainage should be considered as the initial treatment of choice.

Introduction

Secondary spontaneous pneumothoraces (SSP) occur in patients with underlying lung disease such as emphysema, pulmonary tuberculosis, malignant growth, pneumonia, pulmonary fibrosis, and others, in which chronic obstructive pulmonary disease (COPD) accounts for the highest incidence [1]. Several options are available for the treatment of SSP. These include observation, oxygen supplementation, simple aspiration, tube thoracostomy, video-assisted thoracoscopy surgery, and thoracotomy [2], [3], [4]. However, management for SSP remains to be a tough problem because of the lack of widely accepted management guidelines. Guidelines published by the British Thoracic Society recommended observation alone or simple aspiration for treating minimal or asymptomatic SSP and intercostal tube drainage for large pneumothoraces initially [5]. However, Baumann [6] suggested that simple aspiration is probably inappropriate for most SSP episodes because of the greater need for recurrence prevention and the potential for ongoing air leaks. In the aspect of chest tube size selection, there is no evidence to prove that the efficacies of large-bore chest tubes (20F-28F) are any better than that of small-bore pigtail catheter (10F-14F) in the management of pneumothoraces. Besides, traditional large-bore chest tubes may cause more inadvertent damage to the chest wall and the underlying organs than the smaller-bore pigtail catheters. Although many studies have confirmed that small-caliber chest tubes are just as effective as large ones, these studies, however, were primarily targeted on primary spontaneous pneumothoraces [7], [8], [9], [10], [11].

Our previous study and experience in treating primary spontaneous pneumothorax have showed the excellent outcome of small-caliber chest tube (pigtail) drainage [12]; however, its effectiveness in management of SSP is still uncertain. In this study, we used a small-caliber chest tube (pigtail) connecting to a 1-way-valve drainage bag system in the treatment of SSP and also compared the outcome and clinical efficacy of pigtail drainage with the standard water-sealed chest tube in the treatment of SSP.

Section snippets

Patients

Relevant clinical data of patients experiencing the first episode of SSP treated at China Medical University Hospital, a tertiary 1700-bed medical center in central Taiwan, from January 2002 to September 2005 were retrospectively collected and reviewed. The exclusion criteria included primary, traumatic, and iatrogenic pneumothoraces. Recruited patients' chart and chest x-ray (CXR) were carefully reviewed. Only symptomatic patients with a confirmed diagnosis, an adequate follow-up CXR, and

Results

Initially, 143 patients with SPP were screened and then 52 patients were excluded from analysis for the following reasons: younger than 18 years (n = 7), observation only (n = 5), mechanical ventilation–associated barotraumas (n = 33), incomplete follow-up (n = 2), and pyopneumothorax (n = 5). After screening, only 91 patients were enrolled in our series, including 76 (83.5%) men and 15 (16.5%) women. The mean age was 60 years (range, 18-91 years). Sixty-nine patients were initially treated

Discussion

To our knowledge, this is the first study to compare the efficacy of pigtail catheter with large-bore chest tube as the initial treatment for patients presenting the first episode of SSP. In our preliminary data, the overall success rates in patients with SSP treated with pigtail drainage was 72.5%, which was similar to that treating with large-bore chest tube drainage. In addition, there were no significant differences in terms of extubation time, length of hospital stay, and recurrence rates

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