Randomised comparison of needle aspiration and chest tube drainage in spontaneous pneumothorax

Thelle, Andreas; Gjerdevik, Miriam; Sue‐Chu, Malcolm; Hagen, Ole Magnus; Bakke, Per

doi:10.1183/13993003.01296-2016

Cited by 67 publications

(77 citation statements)

References 35 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…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 . Median hospital stay was significantly shorter in the NA group (2.4 vs. 4.6 days).…”

Section: Manual Aspiration or Chest Tube Insertion?mentioning

confidence: 73%

“…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 .…”

Section: Manual Aspiration or Chest Tube Insertion?mentioning

confidence: 82%

See 1 more Smart Citation

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

Plojoux

Froudarakis

Janssens

et al. 2019

Clinical Respiratory J

View full text Add to dashboard Cite

The pathophysiology and management of primary spontaneous pneumothorax (PSP) are a subject of debate. Despite advances in the understanding of its etiopathogenesis and improvements in its management, implementation in clinical practice is suboptimal. In this manuscript, we review the recent literature with a focus on PSP pathophysiology and management. Blebs and emphysema‐like changes (ELC) are thought to contribute to the pathophysiology of PSP but cannot explain all cases. Recent studies emphasize the role of a diffuse porosity of the visceral pleura. Others found a relationship between smoking, occurrence of a PSP and bronchiolitis, which could be the initial pathological process leading to ELC development. Recent or ongoing studies challenge the need to systematically remove air from the pleural cavity of stable patients, introducing conservative management as a valuable therapeutic option. Evidence is growing in favour of needle aspiration instead of chest tube insertion, when air evacuation is needed. In addition, ambulatory management is considered as a successful approach in meta‐analyses and is under exploration in a large randomized study. Because of a high recurrence rate of PSP, the benefit of performing a pleurodesis at first occurrence is under evaluation with interesting but not generalizable results. Better identification of ‘at risk patients’ is needed to improve the investigation strategy. Finally, recent publications confirm the efficacy, security and cost‐effectiveness of graded talc poudrage pleurodesis to prevent PSP recurrence. In conclusion, PSP pathophysiology and management are still under investigation. The results of recently published and ongoing studies should be more widely implemented in clinical practice.

show abstract

Section: Manual Aspiration or Chest Tube Insertion?mentioning

confidence: 73%

Section: Manual Aspiration or Chest Tube Insertion?mentioning

confidence: 82%

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

Plojoux

Froudarakis

Janssens

et al. 2019

Clinical Respiratory J

View full text Add to dashboard Cite

show abstract

“…In this issue of the European Respiratory Journal, THELLE et al [26] have published a randomised study comparing needle aspiration and CTD in 127 patients with spontaneous pneumothorax. This study is interesting for many reasons.…”

Section: @Erspublicationsmentioning

confidence: 99%

“…In the meantime, the study by THELLE et al [26] is an important one to improve the management of both primary and secondary pneumothorax more conservatively. Every clinician also ought to routinely provide more advice about smoking cessation to reduce the chance of recurrence in patients with a first episode of pneumothorax.…”

Section: @Erspublicationsmentioning

confidence: 99%

Spontaneous pneumothorax: stop chest tube as first-line therapy

Tschopp

Marquette

2017

Eur Respir J

View full text Add to dashboard Cite

Spontaneous pneumothorax is traditionally divided between primary spontaneous pneumothorax (PSP) and secondary spontaneous pneumothorax (SSP) when there is some underlying lung disease. For decades management of spontaneous pneumothorax has remained highly debatable despite different published guidelines [1][2][3], many of which contradict each other. Our task force, comprising a multidisciplinary panel of pulmonologists, thoracic surgeons and epidemiologists, recently published a consensus statement [4] on PSP to highlight new findings on the clinical approach, pathophysiology and management strategies of this disease. Pneumothorax remains an under-researched area. The epidemiology of PSP is still poorly documented regarding risk factors or rates of recurrence of PSP. Although smoking remains the principal and well-established risk factor [5], advice for quitting smoking [6] should be routinely given. This disease affects young patients in good health. They are therefore an ideal target population for receiving preventive advice. The pathophysiology of PSP is better understood because of many recent findings. The old concept [7] of PSP because of a localised rupture of a bleb or a bulla is obsolete and has been questioned by many recent studies. We now have robust evidence that the occurrence of PSP is mainly the result of a diffuse histopathological change of the lung parenchyma under the visceral pleura known as emphysema-like changes [8,9]. There is also a diffuse decrease in the lung density measured by computed tomography (CT) [10] and diffuse increased porosity [11] at the periphery of both lungs. These recent findings explain why a localised surgical approach is less effective than a diffuse pleurodesis, whatever the method of pleurodesis used [12,13,14]. Most patients with PSP have no or minimal symptoms, and the entire panel of this European task force [4] agreed that the clinical evaluation of patients with PSP should be more symptom driven and not based only on the measurement of the size of pneumothorax on plain chest radiography or CT, which have little clinical value [15,16]. Tension pneumothorax is very rare [17]. Most patients with spontaneous pneumothorax commonly experience minimal or no symptoms.In recent years, there has been a change in the management strategy of spontaneous pneumothorax leading to more use of a conservative approach [1,3] based on the idea that air in the pleural cavity is well supported. This is not surprising. Chest physicians historically were familiar with inducing artificial pneumothorax in cases of tuberculosis and using the same apparatus for aspirating pneumothorax on an ambulatory basis. With the advent of the chest tube, the use of chest tube drainage (CTD) became widespread although such an approach required hospitalisation and was mainly practised by surgeons [18] and not by pulmonologists. 50 years ago, STRADLING and POOLE [19] had already recommended a conservative and outpatient treatment of pneumothorax. Later on, many randomised studies [20][21][22][23][24...

show abstract

“…Thelle et al (16) performed a randomized controlled study comparing needle aspiration NA versus chest tube drainage CTD in patients with spontaneous pneumothorax. A total of 128 patients were included in three Norwegian hospitals including 48 patients with SSP.…”

Section: Editorialmentioning

confidence: 99%

Is chest tube drainage losing ground in management of patients with spontaneous pneumothorax?

Elsayed

2017

J. Thorac. Dis.

View full text Add to dashboard Cite

Randomised comparison of needle aspiration and chest tube drainage in spontaneous pneumothorax

Cited by 67 publications

References 35 publications

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

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

Spontaneous pneumothorax: stop chest tube as first-line therapy

Is chest tube drainage losing ground in management of patients with spontaneous pneumothorax?

Contact Info

Product

Resources

About