Original contributionCatheter aspiration for simple pneumothorax
Abstract
A prospective study was conducted in the emergency setting to determine the efficacy of treatment of simple pneumothorax by catheter aspiration. Patients who were successfully treated were discharged to home. Sixty-one patients with a total of 76 pneumothoraces were involved in the study. The overall success rate was 75.6%, with an 82% success rate for needle-induced, 75% for traumatic, and 45% for spontaneous pneumothorax. The duration of symptoms, the size of the pneumothorax, the patient's age, and a prior history of pneumothorax did not affect the outcome. The poorest results were noted with spontaneous pneumothoraces, as would be expected since a majority of these patients have preexistent lung disease. Catheter aspiration of simple pneumothorax offers a cost-effective approach to this clinical problem.
References (22)
- C. Bell et al.
Pneumothorax in drug abusers
Ann Emerg Med
(1983) - F. Bevelaqua et al.
Management of spontaneous pneumothorax with small lumen catheter manual aspiration
Chest
(1982) - J. Peters et al.
Clinical evaluation of a percutaneous pneumothorax catheter
Chest
(1984) - O.G. Raja et al.
Simple aspiration of spontaneous pneumothorax
Br JDis Chest
(1981) - S.P. Saha et al.
Management of spontaneous pneumothorax
Ann Thorac Surg
(1975) - W.Y. Inouye et al.
Spontaneous pneumothorax: treatment and mortality
Dis Chest
(1967) - G.J. Hart et al.
Spontaneous pneumothorax in Norfolk
Br J Dis Chest
(1983) - D. Mukherjee et al.
A simple treatment for pneumothorax
Surg Gynecol Obstet
(1983) - C.B. Yeoh et al.
Spontaneous pneumothorax: Treatment with small lumen polyethylene tube
NY J Med
(1970) - S. Sy et al.
Catheter drainage of spontaneous pneumothorax: Suction or no suction, early or late removal
Thorax
(1982)
Management of spontaneous pneumothorax using a Heimlich flutter valve
Thorax
Cited by (17)
Treatment of the first episode of spontaneous pneumothorax
2016, Revue des Maladies RespiratoiresLa prise en charge d’un premier épisode de pneumothorax spontané est controversée et la technique à utiliser en première intention, exsufflation ou drainage, reste discutée.
Nous rapportons les résultats d’une étude rétrospective sur deux années et demie à propos de la prise en charge immédiate du pneumothorax spontané, en comparant l’exsufflation versus le drainage thoracique.
Les dossiers de 133 patients présentant un pneumothorax spontané ont été étudiés (17 pneumothorax primitifs et 116 secondaires). Les épanchements étaient de taille variable et d’étiologies différentes. La prise en charge initiale a consisté en une exsufflation dans 68 cas (taux de succès immédiat de 37,5 %), un drainage thoracique dans 49 cas et le repos seul dans 16 cas.
En cas de pneumothorax secondaire, l’exsufflation était associée à des durées d’hospitalisation moindres qu’avec le drainage thoracique (11 jours versus 22 jours) et un taux de succès immédiat de 37,5 %.
The management of a first episode of spontaneous pneumothorax is controversial and the best technique to be used as an initial intervention, aspiration or intercostal drainage, is still debated.
We present a retrospective case series during two and a half consecutive years describing the immediate management of spontaneous pneumothoraces, comparing aspiration versus thoracic drainage.
One hundred and thirty-three clinical files from patients with spontaneous pneumothoraces were analyzed (17 primary and 116 secondary). The pneumothoraces were of varying size and different etiologies. Patients were initially treated with simple aspiration in 68 cases, with an immediate success rate of 37.5%, intercostal drainage in 49 cases, and by rest alone in 16 cases.
In case of secondary pneumothorax, aspiration appeared to offer advantages as an initial strategy over intercostal drainage in terms of hospital stay (11 versus 22 days), and with significant effectiveness (37.5%).
Comparison of simple aspiration versus standard drainage in the treatment of large primary spontaneous pneumothorax
2011, Revue des Maladies RespiratoiresLe drainage thoracique représente le traitement habituel du pneumothorax spontané complet. L’exsufflation est une technique alternative simple d’apprentissage rapide dont le taux de succès à moyen terme semble identique au drainage. Sa diffusion justifie la réalisation d’études afin de définir sa place dans la stratégie de prise en charge du pneumothorax spontané.
Étude multicentrique, prospective, randomisée, conduite en ouvert et en deux groupes parallèles. L’objectif principal est de comparer l’efficacité thérapeutique d’une exsufflation simple par rapport au drainage thoracique pour un premier pneumothorax spontané complet. L’hypothèse est celle de la non-infériorité de l’exsufflation vis-à-vis du drainage thoracique sur l’efficacité immédiate. Les objectifs secondaires sont de comparer l’efficacité thérapeutique à 24 heures et à une semaine, la récidive à un an, la tolérance du geste, les complications. Une comparaison médicoéconomique des deux techniques est effectuée. Avec un risque α = 0,05 et un risque β = 0,10, une proportion d’échecs attendue de 30 % dans les deux groupes et une borne de non-infériorité de δ = 0,15, le nombre de sujets à inclure est de 200 par groupe, soit au total 400.
En cas d’équivalence, cette étude devrait permettre de mieux situer la place de l’exsufflation comparativement au drainage thoracique.
Chest tube drainage is the standard treatment of a large spontaneous pneumothorax. Aspiration is an alternative technique that is simple and rapid to learn, and the success rate seems identical to chest tube drainage. Its widespread use justifies studies to define its place in the management strategy of spontaneous pneumothorax.
We propose a multicentre, prospective, randomized, open trial with two parallel groups. The main objective is to compare the therapeutic efficacy of a simple aspiration with chest tube drainage for a first large spontaneous pneumothorax. The hypothesis is that aspiration is not inferior to a chest drain in its immediate effect. The secondary objectives are to compare the therapeutic efficacy at 24 h and at one-week, the relapse rate at one year, and the tolerance and complications. A comparison of both the medical and economic aspects will be made. With an α-risk of 0.05 and a β-risk of 0.10, a proportion of failures of 30% expected in both groups and a target of non-inferiority of δ = 0.15, the number of subjects to be included is 200 per group, totalling 400 in all.
In the case of equivalence, this study should help to better define the place of aspiration compared to chest tube drainage in the management of spontaneous pneumothorax.
Economic issues in observation unit medicine
2001, Emergency Medicine Clinics of North AmericaEmergency department (ED) observation units (OU) improve the use of health care resources and improve the quality of patient care. Costs increase with observation of patients who would otherwise have been released after the ED evaluation. Observation improves the quality of patient care by identifying patients whose diagnosis otherwise would be missed because they presented with atypical symptoms, for example, an acute myocardial infarction (MI) patient presenting with shortness of breath (SOB). Costs decrease with observation of patients who would otherwise have been admitted to the hospital after the ED evaluation. Observation evaluates patients for serious disease who otherwise would have been admitted to the hospital. This improves utilization because 80% of patients are found during observation to not have a serious disease and therefore can avoid hospitalization. The overall financial effect with observation is cost savings because of avoidance of hospital admissions and the avoidance of those costs.
This article examines the overall economic effect of implementing ED observation units, which varies at individual institutions depending on the physicians' threshold for hospitalization of patients. Avoiding hospitalization with observation does dramatically lower the costs to healthcare system. Most healthcare costs are due to hospitalizations, and the costs are reduced over 50% for patients managed in observation units.1, 2, 3, 4, 5, 6, 8, 10, 12, 13, 17, 19, 20, 25, 26, 27, 29, 31, 35, 36, 40, 41, 43 Affects on profitability (costs versus revenue) of those participating in this healthcare reform (e.g., the payer, the physician, the hospital) is more difficult to predict given the large variability in contract negotiations between payers and providers over payment (revenue) and the variability in efficiency of clinical paths constructed in different observation units.
Even after decades of health care cost-containment activity aimed at health care, cost increases continue to be of critical concern. This article outlines the issues related to cost that affect physicians and others making patient care decisions about observation units. Many of these same issues are applicable to other areas of medicine as well. Physicians must be familiar with these concepts, because in the current practice of medicine they directly or indirectly influence everything they do.
This article begins with definitions of important economic terms, then follows with a brief review of some of the literature on observation unit cost outcomes. Clinical studies are reviewed on the cost-saving aspects of implementing an observation unit to manage selected patients with different clinical conditions. The economic impact of implementing ED observation units is reviewed from the perspective of the different participants in the health care system (e.g., hospital, payer, patient, and physician).
Management of Observation Units
1995, Annals of Emergency Medicine[American College of Emergency Physicians: Management of observation units. Ann Emerg Med June 1995;25:823-830.]
The treatment of spontaneous pneumothorax in the civilian population can be influenced by the age of the patient and the presence of associated pulmonary disease. The medical records of 130 patients who presented with 168 occurrences of SP were reviewed during an 11-year period (1973 to 1984). Follow-up was from a minimum of 30 months to 13 years (mean 6.3 years). The therapeutic options included observation alone (40 occurrences), thoracentesis (6 occurrences), chest tube thoracostomy (102 occurrences), and thoracotomy (20 occurrences). Treatment of SP should be prompt with the objective of complete re-expansion of the lung and prevention of recurrent pneumothorax. This should be accomplished by the use of chest tube thoracostomy with early addition of thoracotomy as necessary. Selected use of thoracentesis can be effective. The use of observation alone can be dangerous and is associated with a higher recurrence rate.
Sequential treatment of a simple pneumothorax
1988, Annals of Emergency MedicineIn a prospective investigation of isolated simple pneumothorax, the treatment of 35 patients with a total of 37 pneumothoraces was studied. A standardized sequential treatment approach was followed for evacuation of the pneumothorax and maintenance of lung reexpansion. The protocol involved catheter placement using a Seldinger technique, aspirations, and documentation of reexpansion by chest radiography and observation. Reaccumulation of air was treated with Heimlich valve attachment to the catheter at intrapleural pressure and further observation. Continued air leak following Heimlich valve attachment was treated with chest catheter suction using a Pleurovac® at −20 cm H2O pressure. Chest tube thoracostomy was performed for continued failure of reexpansion. In 22 of the 37 pneumothoraces (59%) simple catheter aspiration maintained lung reexpansion without complications. In the remaining 15 pneumothoraces (41%), seven (47%) responded to Heimlich valve attachment, and three (20%) maintained expansion with chest catheter suction. Chest tube thoracotomy was required to maintain expansion in 33% (five) of those who failed catheter suction (14% of all pneumothoraces studied). Patients treated successfully with simple catheter aspiration were sent home. Patients requiring a Heimlich valve, chest catheter suction, or chest tube thoracostomy were hospitalized. Use of these catheter techniques resulted in lower cost and was associated with shorter hospitalizations than in chest tube thoracostomy. Our study suggests that sequential treatment of simple pneumothorax should be considered as a cost-effective and therapeutically successful alternative to immediate chest thoracostomy in selected cases.