Management of pneumothorax with a mini-drain in ambulatory and hospitalized patients

Abstract

The function of the mini-drain was satisfactory in the majority of cases, but cases with pleural fluid should be avoided. The recurrences were more due to the severe nature of the pulmonary leak rather than to inadequacy of the drain. The side effects mostly occurred in the first patients, so there was a learning curve. The new system should be tried in all patients presenting with an uncomplicated pneumo-thorax allowing ambulatory treatment. Patients with other diseases complicated by pneumothorax could have the new system in order not to be confined to bed. The new system has no place in patients bedridden due to other severe diseases.

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

“…Figure 1 presents a flow chart for full breakdown in the identification of suitable studies. This included two RCTs20 21 and three prospective series,17 18 22 the rest were retrospective case series 15 23–34. There were 992 cases of SP (of which 413 were reported as PSP) and 243 IP.…”

“…There were 992 cases of SP (of which 413 were reported as PSP) and 243 IP. Two studies included reports on postsurgical patients, from which the results were clearly separated from SP and IP, allowing inclusion 18 24 Table 1. provides a summary of included reports.…”

“…This is not a new concept, with reports in the literature dating back to 197315 advocating the use of a Heimlich flutter valve (HV: a lightweight one-way valve specifically designed for the ambulatory treatment of pneumothorax16) attached to an intercostal catheter with patients managed out of hospital. This approach is very attractive to patients as it does not involve connection to a drain bottle, and thus, encourages mobility and ability to more comfortably perform common activities of daily living 17 18…”

Gestes pleuraux sous antiagrégants plaquettaires : une enquête d’opinion

“…Cette opinion concorde avec les données de la littérature qui rapportent une incidence des complications hémorra-giques après drainage thoracique chez des patients sans AAP entre 0 et 4,2 % [11][12][13][14][15][16][17][18][19][33][34][35][36][37]. Une étude prospective monocentrique a rapporté l'absence de complication hémorragique au cours de 24 drainages thoraciques réalisés sous clopidogrel [38].…”

“…Les données existantes sont principalement issues de patients sans AAP, ce qui amène à des interprétations variables du risque hémorragique des gestes pleuraux. En effet, si on considère l'incidence des complications hémorragiques (hémothorax, hémoptysie et hématome de paroi), les ponctions pleurales [4][5][6][7][8][9][10] et les drainages thoraciques [11][12][13][14][15][16][17][18][19] peuvent être considérés à faible risque hémorragique (incidence < 5 %) alors que les biopsies pleurales auraient un risque hémorragique faible ou majeur en fonction des séries [20][21][22][23]. Mais le risque vital lié à ces complications a amené certains auteurs à considérer de principe les gestes pleuraux comme étant à haut risque hémorragique [24].…”