Outpatient management of primary spontaneous pneumothorax: a prospective study

Abstract

We prospectively assessed the safety and cost saving of a small-bore drain based procedure for outpatient management of first episodes of primary spontaneous pneumothorax.Patients were managed by observation alone or insertion of an 8.5-F ''pig-tail'' drain connected to a oneway valve, according to size and clinical tolerance of the pneumothorax. All patients were reassessed after 4 h, on the first working day after discharge and on day 7. Patients still exhibiting air leak on day 4 underwent thoracoscopy. The primary end-point was complete lung re-expansion at day 7.60 consecutive patients entered the study. 48 (80%) met the definition of large pneumothorax. The success rate was 83%. The 1-year recurrence rate was 17%. 36 (60%) patients were discharged after 4 h and 50% had full outpatient management. No severe complication was observed. The mean¡SD length of hospitalisation was 2.3¡3.1 days. This policy resulted in about a 40% reduction in hospital stay-related costs.The present study supports the use of a single system combined with a well-defined management algorithm including safe discharge criteria, as an alternative to manual aspiration or chest tube drainage. This approach participates in healthcare cost-savings. @ERSpublications Primary spontaneous pneumothorax can be managed outside the hospital, subject to strict predischarge safety criteria

Recurrence of Spontaneous Pneumothorax Is Not Associated with Allegedly Risk-Prone Lifestyle Conduct

“…[1][2][3] Several guidelines and consensus statements about the treatment of primary PNTX exist and VATS procedures have become the mainstay of therapy and prevention of recurrences. 5) While long-term results regarding recurrence prevention by VATS for PNTX therapy have been reported extensively in the literature, no data are available concerning recurrence-prone risk behavior of operated patients.…”

“…Without specific surgical therapy, recurrence rates of primary PNTX were reported between 4% and 17%, depending on the applied interventional method. [1][2][3] Videothoracoscopic surgery (VATS) including pulmonary wedge resection and parietal pleurectomy has become Ann Thorac Cardiovasc Surg Advance Published Date: December 27, 2017 doi: 10.5761/atcs.oa. the standard of care for PNTX treatment and recurrence prevention.…”

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

“…Of these, 20% were characterized as small and all were successfully managed with observation alone. 29 In the remaining 80% that were characterized as large, all patients underwent placement of a smaller 8.5 French pigtail catheter. 29 79.2% of these patients were successfully managed with the catheter alone.…”

“…29 In the remaining 80% that were characterized as large, all patients underwent placement of a smaller 8.5 French pigtail catheter. 29 79.2% of these patients were successfully managed with the catheter alone. 29 20.8% of the patients went on to require video-assisted thoracoscopy for definitive management of the PTX.…”

“…29 20.8% of the patients went on to require video-assisted thoracoscopy for definitive management of the PTX. 29 These studies make the strong argument for the management of hemodynamically stable patients with spontaneous PTX, even of a larger size, as outpatients with a smaller thoracostomy tube attached to a Heimlich valve. An alternative management strategy is needle aspiration using an intravenous catheter.…”