Randomized controlled trial on the comparison of chest tube drainage and needle aspiration in the treatment of primary spontaneous pneumothorax

Abstract

Objectives:To evaluate the efficacy of the chest tube drainage (CTD) and the needle aspiration (NA) in the treatment of primary Spontaneous pneumothorax (SP).Methods:In a randomized controlled trial, seventy patients suffering SP were divided equally into two subgroups, as follows: (A) CTD and (B) NA. The immediate and one-week rate of the treatments was the primary endpoints. Postoperative complications, length of hospital stay and incidence of pneumothorax recurrence during one-year follow up were also recorded.Results:The immediate success of treatment was 68.5% and 54.2% of patients in CTD and NA groups, respectively that showed no significant difference between study groups (P: 0.16). The complete lung expansion after one week observed in 32 (91.4%) of NA group and 33 (94.2%) patients in CTD group (P: 0.5). Pneumothorax recurrence was detected in 13 patients (4 in NA and 9 in CTD group) (P: 0.11). Mean pain intensity was significantly lower in the NA group at the first hour after the procedure, the first postoperative day and the first week after the intervention (P< 0.001).Conclusion:Needle aspiration (NA) can be applied as a first step treatment in patients with primary SP, considering its advantages.

An evidence‐based review of primary spontaneous pneumothorax in the adolescent population

“…In adults, recent RCTs and a Cochrane review comparing both methods found no differences in recurrence rates, whereas needle aspiration resulted in shorter duration of hospitalization and fewer adverse events. [68][69][70][71] In contrast to adults, tube thoracostomy is favored over needle aspiration in pediatric patients. Retrospective and prospective studies examining needle aspiration in pediatric patients with PSP report success rates of approximately 50%, which is lower than cited rates in adults.…”

Needle aspiration for treating iatrogenic pneumothorax after cardiac electronic device implantation: a pilot study

“…It is traditionally treated by largebore chest tube drainage. Nevertheless, it has recently been shown that primary and secondary spontaneous pneumothoraces could also be treated successfully with the novel, less invasive needle aspiration technique [7][8][9]12]. It is less traumatic for the patient and may help to shorten hospitalization.…”

“…Simple pneumothoraces, however, could also be treated successfully with the less invasive catheter aspiration as was shown by Delius et al in 1989: for needle-induced PTX the success rate was 75% [7]. Similarly, needle aspiration (NA) has been found to be effective for primary and secondary spontaneous pneumothoraces in recent randomized trials [8,9]. Compared with chest tube thoracostomy, needle aspiration is less traumatic and may help to shorten hospital stay thereby reducing costs.…”

New insights into spontaneous pneumothorax: A review

“…Needle aspiration has been shown to be effective, with decreased length of hospital stay, decreased complications and similar recurrence rates compared with ICD. [29][30][31][32] However, needle aspiration fails if the air leak is still present at the time of the procedure. It has been shown that compliance with the BTS guidelines in general is poor and most clinicians favour ICD insertion as primary intervention over needle aspiration.…”

“…There is also a perception that needle aspiration is more time-consuming in the emergency unit setting. [32] In general, we would recommend that in patients with spontaneous pneumothorax who are judged to need intervention, are not in extremis, and the risk of persistent air leaks is judged to be low, needle aspiration may be attempted first. If needle aspiration is not possible or has failed, it is advised to insert a small-bore ICD.…”