Chest tube drainage versus needle aspiration for primary spontaneous pneumothorax: which is better?

Abstract

Background: Needle aspiration and chest tube drainages are two main treatments for primary spontaneous pneumothorax (PSP). However, the application of needle aspiration or chest tube drainages has not reached a consensus. The aim of this study is to compare the needle aspiration with chest tube drainages in patients suffering with PSP and therefore help offer suggestions for clinical practice. and risk ratio (RR) respectively, and each with 95% confidence intervals (CIs). We used the fixed effect or random effect model to perform quantitative synthesis.Results: A total of 6 RCTs recruiting 458 participants were included in our analysis. On the basis of the six studies, our results indicated that compared with chest tube drainage applying needle aspiration shortened the hospital stay (WMD: -1.67 days; 95% CI: -2.25 to 1.08; P<0.001) and decreased hospitalization rate (RR: 0.40; 95% CI: 0.22-0.75; P=0.004). However, there was no difference regarding immediate success rate (RR: 1.01; 95% CI: 0.70-1.46; P=0.96) and one-year recurrence rate (RR: 0.89; 95% CI: 0.58-1.38; P=0.61). Conclusions:In the light of this present research, it is necessary to apply needle aspiration into treating PSP to reduce hospitalization rate and shorten hospital stay. However, the two treatments have no significant difference with respect to immediate success rate, one-year recurrence rate, one-week success rate, three-month recurrence rate or complication rate.

New insights and improved strategies for the management of primary spontaneous pneumothorax

“…A recent Cochrane systematic review (2017) also reported a shorter hospital stay and a reduction of side effects after simple NA compared to chest tube drainage (CTD) . Another review of well‐conducted randomized studies published the same year and including results of the largest study in this field by Thelle et al came to the same conclusions . Thelle recently published a randomized controlled study of 127 patients with pneumothorax (79 PSP and 48 SSP) comparing NA with CTD .…”

A Prospective Randomized Trial Comparing Manual Needle Aspiration to Closed Thoracostomy as an Initial Treatment for the First Episode of Primary Spontaneous Pneumothorax

“…In PSP patients with a small pneumothorax (size ≤25%), the general consensus is that observation with O2 inhalation is most appropriate [6,7]. However, there is no clear guideline for PSP patients with a large pneumothorax (size >25), and variations exist in international guidelines and clinical practice [8,9]. These discrepancies arise from a lack of high-quality evidence obtained from a variety of prospective studies [6,10].…”

Exclusive ambulatory management of spontaneous pneumothorax with pigtail catheters, a prospective multicentric study

“…NA and CTD were compared in two recent meta-analyses. 23,24 Both studies acknowledged that NA is associated with a shorter stay in hospital but the Cochrane analysis concludes that CTD had a higher immediate success rate, although there was little supporting evidence. Walker and Maskell point out in their editorial that, while NA is associated with fewer bed days and adverse events, it has an initial risk of failure rate of 50%.…”