Chest
Volume 108, Issue 2, August 1995, Pages 335-339
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Clinical Investigations; Articles; Thoracic Surgery
Spontaneous Pneumothorax: Comparison of Thoracic Drainage vs Immediate or Delayed Needle Aspiration

https://doi.org/10.1378/chest.108.2.335Get rights and content

In the first part of this study, 61 patients admitted for the first episode or the first recurrence of a spontaneous pneumothorax (SP) were randomly treated with thoracic drainage (TD; 28 patients) or with simple needle aspiration (NA; 33 patients). Success rate of therapy was significantly higher with TD than with NA (93%, CI 84 to 100 vs 67%, CI 51 to 83; p=0.01). Hospital stay was similar between the two groups (7±4.6 vs 7±5.6 days), mainly because NA was delayed by 72 h in 26 patients. Recurrence rates at 3 months were 29% (CI 11 to 47%) after TD, and 14% (CI 0 to 29%) after NA (p>0.20, NS). In the second part of the study, an additional population of 35 patients was treated by immediate NA, with a success rate of 68.5% (CI 53.5 to 83.5%), and a recurrence rate at 3 months of 30% (CI 10 to 50%). Taken together, our results indicate that NA may be proposed as a first-line treatment of SP, with a successful result in two thirds of patients and recurrence in one fifth of patients. In patients who do not heal with NA, a combined risk of TD failure and short-term recurrence of 50% may be an incentive for undelayed surgical procedures.

(CHEST 1995; 108:335-40)

Section snippets

Patients

Patients older than 18 years were considered for the present study if they were suffering from a first episode or first recurrence of a complete SP. Patients were not included when presenting any of the following: posttraumatic, iatrogenic, or bilateral pneumothorax; third ipsilateral episode or more; moderate-to-major associated pleural effusion or hemothorax; contralateral emphysematous bullae; suspected or proven lung cancer, lung abscess, or consolidated pneumonia; diffuse interstitial

First Protocol

Sixty-one patients were included in this protocol, 33 of them randomized to NA and 28 to TD. Some relevant clinical data for these two populations are depicted in Table 1. There were no significant differences between these two groups.

Short-term Efficacy of Therapy: Twenty-two and 26 patients were successfully treated with NA alone and with TD, respectively. This led to a significantly higher success rate for TD when compared with NA (93%, CI 84 to 100%, vs 67%, CI 51 to 83%; p=0.01). Nine of

Discussion

The present prospective study addressed three important issues concerning medical treatment of SP, namely short-term efficacy of NA vs TD, timing of NA (ie, immediate vs delayed thoracocentesis), and recurrence rates with both techniques.

In the randomized part of the trial, we observed that TD via a chest tube was significantly more effective in the treatment of pneumothorax than NA via a small-caliber plastic needle. It must be noted, however, that criteria for TD failure were far more

ACKNOWLEDGMENTS

The authors are indebted to Drs. Emmanuel Antoni and Kaï Kollenbach for their personal contribution in the realization of the study, and to Dr. Pierre Aslanian for his expert review of the manuscript.

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This work has been presented in part at the conference of the American Thoracic Society, Anaheim, Calif, May 12-15, 1991.

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