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Pleural Disease
Original article
Longer symptom onset to aspiration time predicts success of needle aspiration in primary spontaneous pneumothorax
  1. Constance Vuillard1,2,
  2. Fadia Dib3,4,5,
  3. Jallal Achamlal6,
  4. Stéphane Gaudry7,8,9,
  5. Damien Roux1,2,
  6. Myriam Chemouny6,
  7. Nicolas Javaud6,
  8. Didier Dreyfuss2,9,
  9. Jean-Damien Ricard1,2,
  10. Jonathan Messika2,10
  1. 1 Université de Paris, Infection, Antimicrobials, Modelling, Evolution, IAME, UMR 1137, INSERM, F-75018, Paris, France
  2. 2 Service de Réanimation Médico-Chirurgicale, AP-HP, Hôpital Louis Mourier, F-92700, Colombes, France
  3. 3 Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Department of Social Epidemiology, INSERM, F-75012 Paris, France
  4. 4 CIC Cochin Pasteur, AP-HP, Hôpital Cochin, F-75014 Paris, France
  5. 5 INSERM CIC 1417, F-CRIN, I-REIVAC, F-75014, Paris, France
  6. 6 Service d’Accueil des Urgences, AP-HP, Hôpital Louis Mourier, F-92700, Colombes, France
  7. 7 Université Paris-Nord, F-93000, Bobigny, France
  8. 8 Service de Réanimation Médico-Chirurgicale, AP-HP, Hôpital Avicenne, F-93000, Bobigny, France
  9. 9 Sorbonne Université, UMR_S1155, Common and Rare Kidney Diseases: from Molecular Events to Precision Medicine, Hôpital Tenon, F-75020, Paris, France
  10. 10 Université de Paris, Physiopathology and Epidemiology of Respiratory Diseases, PHERE, UMR1152, INSERM, F-75018 Paris, France
  1. Correspondence to Dr Jonathan Messika, Colombes, France; jonathan.messika{at}aphp.fr

Abstract

Background Needle aspiration (NA) is recommended as first-line treatment of primary spontaneous pneumothorax (PSP). We aimed to assess NA success and the effect of a longer symptom onset to NA time.

Methods A discovery phase was retrospectively conducted in the intensive care unit of Louis Mourier Hospital (January 2000 to December 2011) followed by a prospective validation cohort (January 2012 to August 2015). The primary outcome was immediate NA success defined by the absence of need for chest tube insertion within 24 hours of the procedure.

Results In the discovery phase, 130 patients were admitted for PSP and 98 had NA as first-line treatment (75%). The immediate success rate of NA was 34.7% and was higher when it was performed ≥48 hours after symptom onset (57.7% vs 25%; p=0.004). In the prospective cohort, 87 patients were admitted for PSP; 71 (82%) had NA as first-step treatment. The immediate success rate was 40.8%. NA was more successful when it was performed after 48 hours of symptoms’ onset (34.5% vs 7.1%; p=0.005). A delay between the first symptom and NA procedure ≥48 hours was associated with a higher success of NA (OR=13.54; 95% CI 1.37 to 133). A smaller pneumothorax estimated by Light’s index was associated with NA success (OR=0.95; 95% CI 0.92 to 0.98). To what extent some of these pneumothoraces would have had a spontaneous resolution remains unknown.

Conclusion When managing PSP with NA, a longer symptom onset to NA time was associated with NA success.

Trial registration number NCT02528734.

  • pneumothorax
  • needle aspiration
  • pleural drainage

http://dx.doi.org/10.1136/thoraxjnl-2019-213168

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    Footnotes

    • Contributors CV, J-DR and JM contributed to the manuscript’s conception, design, drafting and critical revision, and agreed to be accountable for all aspects of the work. FD, JA and DD made substantial contributions to analysis and interpretation of data, were involved in drafting the manuscript, gave approval of the present version of the manuscript and agreed to be accountable for all aspects of the work. SG, DR, MC and NJ made substantial contributions to interpretation of data, revised the manuscript for important intellectual content, gave approval of the present version of the manuscript and agreed to be accountable for all aspects of the work.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests J-DR and JM received reimbursement of congress fees from Fisher & Paykel.

    • Patient consent for publication Not required.

    • Ethics approval The Ethics Committee of the French National Society of Intensive Care (SRLF, CE 12-364 and 14-08) approved the study.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data are available on reasonable request.

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    © Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.

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