Management of Spontaneous Pneumothorax and Post-Interventional Pneumothorax: German S3 Guideline

Schnell, Jost; Beer, Meinrad; Eggeling, Stephan; Gesierich, Wolfgang; Gottlieb, Jens; Herth, Felix J.F.; Hofmann, Hans‐Stefan; Jany, B; Kreuter, Michael; Ley‐Zaporozhan, Julia; Scheubel, R.; Walles, Thorsten; Wiesemann, Sebastian; Worth, H.; Stoelben, Erich

doi:10.1159/000490179

Cited by 61 publications

(59 citation statements)

References 240 publications

(324 reference statements)

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“…Surgical intervention of PALs has been the definitive approach in patients in whom air leaks do not resolve using conservative means [6, 11, 23]; however, many SSP patients are not fit for surgery by virtue of the severity of their underlying diseases, or are unwilling to proceed with surgery. Under these circumstances, bronchoscopic techniques have been among the therapeutic options for decades [3, 7].…”

Section: Discussionmentioning

confidence: 99%

Management of Persistent Air Leaks Using Endobronchial Autologous Blood Patch and Spigot Occlusion: A Multicentre Randomized Controlled Trial in China

Zhang¹,

Xie²,

Gu³

et al. 2019

Respiration

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Background: Optimal management of persistent air leaks (PALs) in patients with secondary spontaneous pneumothorax (SSP) remains controversial. Objective: To evaluate the efficacy and safety of endobronchial autologous blood plus thrombin patch (ABP) and bronchial occlusion using silicone spigots (BOS) in patients with SSP accompanied by alveolar-pleural fistula (APF) and PALs. Methods: This prospective multicentre randomized controlled trial compared chest tube-attached water-seal drainage (CTD), ABP, and BOS that were performed between February 2015 and June 2017 in one of six tertiary care hospitals in China. Patients diagnosed with APF experiencing PALs (despite 7 days of CTD) and inoperable patients were included. Outcome measures included success rate of pneumothorax resolution at the end of the observation period (further 14 days), duration of air leak stop, lung expansion, hospital stay, and complications. Results: In total, 150 subjects were analysed in three groups (CTD, ABP, BOS) of 50 each. At 14 days, 60, 82, and 84% of CTD, ABP, and BOS subjects, respectively, experienced full resolution of pneumothorax (p = 0.008). All duration outcome measures were significantly better in the ABP and BOS groups than in the CTD group (p < 0.016 for all). The incidence of adverse events, including chest pain, cough, and fever, was not significantly different. All subjects in the ABP and BOS groups experienced temporary haemoptysis. Spigot displacement occurred in 8% of BOS subjects. Conclusion: ABP and BOS resulted in clinically meaningful outcomes, including higher success rate, duration of air leak stop, lung expansion, and hospital stay, with an acceptable safety profile.

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Section: Discussionmentioning

confidence: 99%

Management of Persistent Air Leaks Using Endobronchial Autologous Blood Patch and Spigot Occlusion: A Multicentre Randomized Controlled Trial in China

Zhang¹,

Xie²,

Gu³

et al. 2019

Respiration

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“…However, overtreatment would occur if such recommendations were followed. The most recent German S3 guideline recommends VATS in selected cases of first-episode PSP [18], similar to the BTS and ACCP guidelines. In our study, sex, BMI, smoking history, and HRCT findings were not useful in the risk stratification of ipsilateral recurrence; only younger age was useful for this purpose.…”

Section: Discussionmentioning

confidence: 99%

Do Blebs or Bullae on High-Resolution Computed Tomography Predict Ipsilateral Recurrence in Young Patients at the First Episode of Primary Spontaneous Pneumothorax?

Park

Jang

Song

et al. 2019

Korean J Thorac Cardiovasc Surg

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Background The relationship between the size of bullae and pneumothorax recurrence is controversial. The aim of this study was to retrospectively evaluate the role of blebs or bullae in predicting ipsilateral recurrence in young patients experiencing their first episode of primary spontaneous pneumothorax (PSP) who underwent conservative treatment. Methods A total of 299 cases of first-episode PSP were analyzed. The status of blebs or bullae was reviewed on high-resolution computed tomography (HRCT). The dystrophic severity score (DSS; range, 0 to 6 points) was calculated based on HRCT. Results The 5-year recurrence rate was 38.2%. In univariate analysis, age (<20 years), body mass index (<20 kg/m 2 ), a unilateral lesion, and intermediate risk (DSS 4 and 5) were associated with recurrence. Sex; smoking history; and the presence, number, and maximal size of blebs or bullae were not related to recurrence. In Cox regression, age and intermediate risk were independent risk factors for recurrence. High risk (DDS 6) was not an independent risk factor. Conclusion The presence, number, and size of blebs or bullae did not affect ipsilateral recurrence. DSS failed to show a positive correlation between severity and recurrence. The decision to perform surgery in patients experiencing their first episode of PSP should not be determined by the severity of blebs and bullae.

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“…Thoracic ultrasound (TUS) is an appropriate tool for the exclusion of a pneumothorax and has been widely researched in critical care and emergency settings [4,5]. It is, therefore, mentioned as a comparable tool when compared to X-ray for the exclusion of pneumothorax and, e.g., is mentioned in the latest German guideline [6]. Exclusion of a pneumothorax in the supine position with overall detection of either lung sliding or lung pulse, while the visualization of a lung pulse confirms a pneumothorax [7].…”

Section: Introductionmentioning

confidence: 99%

Thoracic Ultrasound for Immediate Exclusion of Pneumothorax after Interventional Bronchoscopy

Eisenmann

Winantea

Karpf-Wissel

et al. 2020

JCM

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Background. Pneumothorax is a common side effect in interventional pulmonology. The ideal moment for detection with chest X-ray or ultrasound has not yet been defined. Earlier studies demonstrated the utility of performing these tests with a certain delay, which always results in a potentially dangerous gap. Methods. We prospectively enrolled patients with pulmonary interventions at increased risk of pneumothorax. Thoracic ultrasound was performed immediately after the intervention and at the moment of chest X-ray with a delay up to two hours. Results: Overall, we detected four pneumothoraxes in 115 procedures. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy were 75%, 100%, 100%, 99%, 99% for ultrasound and 75%, 90%, 21%, 99% und 89% for chest X-ray respectively. All pneumothoraces requiring chest tube were sufficiently detected by both methods. Conclusion. Thoracic ultrasound when performed immediately can more accurately exclude pneumothorax after interventional bronchoscopy when compared to chest X-ray. Further ultrasound examinations are unnecessary.

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Management of Spontaneous Pneumothorax and Post-Interventional Pneumothorax: German S3 Guideline

Cited by 61 publications

References 240 publications

Management of Persistent Air Leaks Using Endobronchial Autologous Blood Patch and Spigot Occlusion: A Multicentre Randomized Controlled Trial in China

Management of Persistent Air Leaks Using Endobronchial Autologous Blood Patch and Spigot Occlusion: A Multicentre Randomized Controlled Trial in China

Do Blebs or Bullae on High-Resolution Computed Tomography Predict Ipsilateral Recurrence in Young Patients at the First Episode of Primary Spontaneous Pneumothorax?

Thoracic Ultrasound for Immediate Exclusion of Pneumothorax after Interventional Bronchoscopy

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