Ambulatory treatment in the management of pneumothorax: a systematic review of the literature

“…Complications were rare. 28 In a 2014 article by Voisin et al 2 , 132 patients with spontaneous PTX were managed as outpatients with a pigtail thoracostomy tube attached to a Heimlich flutter valve. Of these 132 patients, 110 had primary PTX and 22 had secondary PTX.…”

Section: Management Options For Spontaneous Pneumothoraxmentioning

confidence: 99%

Diagnosis and Management of Spontaneous Pneumothorax in the Emergency Department: A Review of the Most Current Clinical Evidence for Diagnosis and Treatment

Chong¹,

Chao²,

Hunter-Behrend³

et al. 2016

Pulm Res Respir Med Open J

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Background: Spontaneous non-traumatic pneumothorax is a relatively common clinical presentation in the Emergency Department. The diagnosis of spontaneous non-traumatic pneumothorax has evolved from basic chest radiography to the reference standard of CT imaging. Point-of-care ultrasound is another highly sensitive diagnostic modality that has gained increasing acceptance. Finally, the treatment of this type of pneumothorax has also been rapidly changing. Objective: We give an overview of the current literature regarding the definition and classification for pneumothorax. We discuss the current methods of diagnosis and management of spontaneous non-traumatic pneumothorax, which now include the promising treatment alternative of smaller pigtail thoracostomy catheters. We also discuss how a rapidly placed smaller pigtail catheter may be a viable single management option for a spontaneous tension pneumothorax. Discussion: The management of spontaneous non-traumatic pneumothorax has been rapidly advancing. Viable treatment options now include observation alone, needle aspiration and placement of a small pigtail thoracostomy catheter, in addition to the use of a traditional thoracostomy tube. Conclusion: Although the traditional treatment for a spontaneous non-traumatic pneumothorax was placement of a larger thoracostomy tube, this may no longer be the optimal management approach in these patients. The use of smaller pigtail thoracostomy catheters provides a viable treatment alternative to these larger catheters, and may also be used effectively as the only treatment step in a spontaneous tension pneumothorax. Placement of these smaller catheters sets the stage for potential outpatient management of pneumothorax, with increased comfort for the patient and possible cost savings.

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“…The ambulatory success rate of 78% documented in the article by Voisin et al 4 is comparable to the success rate for the use of Heimlich valve alone for the treatment of pneumothorax in a 2013 systematic review of 1,235 patients (77.9%; 95% confidence interval 75.2% to 80.4%). 10 There was a range of opinion about the optimal intervention comparison. Randomized controlled trial designs suggested in blog comments included the following:…”

Section: Social Media Analyticsmentioning

confidence: 99%

“…9,10 Stiles also noted a study currently under review advocating an aggressive strategy for early (ie, next-day) primary pleurodesis, given the high pneumothorax recurrence rate of up to 50% during 4 years, referencing Sadikot et al 11 at the request of another blog participant.…”

Section: Social Media Analyticsmentioning

confidence: 99%