Role of small calibre chest tube drainage for iatrogenic pneumothorax.

Laub, M.; Milman, Nils; Müller, D; Struve-Christensen, E

doi:10.1136/thx.45.10.748

Cited by 35 publications

(23 citation statements)

References 8 publications

(1 reference statement)

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“…Subsequent studies included first episodes and recurrences of PSP, as well as secondary, traumatic and iatrogenic PTX [16][17][18][19][20][21]. Except for one study [16], the catheters were catheter-over-needle systems, with no shielding of the needle tip, and were placed either with [13][14][15]23] or without [16][17][18][19][20][21][22]24] radiological or ultrasound guidance. Not surprisingly, suction applied to these small catheters functioned as well as simple MA.…”

Section: Discussionmentioning

confidence: 99%

“…When suction failed to give immediate re-expansion, connection to a one-way valve was advised, eventually followed by wall suction if the air leak continued. The failure rate of catheter wall suction when MA had failed ranged from 8-31% [16,[18][19][20][21]. Most of these studies were retrospective and therefore did not follow clear recommendations regarding the stepwise management of underlying air leaks.…”

Section: Discussionmentioning

confidence: 99%

“…Such small catheters have proved successful in mixed pneumothorax (PTX) populations, most of them being iatrogenic [13][14][15][16][17][18][19][20][21][22][23][24]. The purpose of the present study was to assess the feasibility, safety and effectiveness of a comprehensive therapeutic algorithm that used small-calibre catheters connected to a one-way valve in first episodes of PSP.…”

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confidence: 99%

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Simplified stepwise management of primary spontaneous pneumothorax: a pilot study

Ch¹

2006

Eur Respir J

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In primary spontaneous pneumothorax (PSP) requiring intervention, removal of air from the pleural space can be achieved by manual needle aspiration or by pleural drainage after insertion of a chest tube. This study aimed to evaluate the efficacy and safety of a serial-steps approach with a single system (small-calibre catheter/Heimlich valve) in a homogeneous population of patients with a first episode of PSP.All patients had an 8.5 F distally multiperforated polyurethane pigtail catheter inserted via the anterior route, at the bedside without any guidance, using the Seldinger technique. A one-way Heimlich valve was connected to the catheter, allowing the air to flow spontaneously outwards for 24-48 h. Thereafter, if the lung failed to re-expand wall suction was applied. Patients with an air leak persisting for .4 days were referred for surgery. Primary end-points were success rates at 24 h and 1 week, and 1 yr recurrence-free survival.In total, 41 consecutive patients entered the study. They were typically thin, young, smoking males. No procedure-related complications were observed. The need for pain relief medication was minimal. Within the first 24 h, most of the patients were able to walk around and half of them were able to take a shower with their catheter in place. The 24-h and 1-week success rates were 61 and 85%, respectively, and the actuarial 1-yr recurrence rate was 24%. Four patients underwent surgical pleurodesis because of a persistent air leak. The length of stay when excluding the four surgical cases was 2.3¡1.3 days.When 24-h and 1-week success rates and recurrence at 12 months were taken as end-points, the method described here is as effective as simple manual needle aspiration or a conventional chest tube thoracotomy. These results support further studies assessing this ''one system, serialsteps approach'' in an outpatient management algorithm.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Simplified stepwise management of primary spontaneous pneumothorax: a pilot study

Ch¹

2006

Eur Respir J

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“…Narrow bore drains have been used successfully for the treatment of pneumothoraces for over a decade,2 3 and have the advantage over large intercostal drains in that they are free from the troublesome complication of subcutaneous emphysema that follows blunt dissection through the parietal pleura. Narrow bore chest drains that are quick, safe, and easy to insert by a Seldinger technique (for example, the Portex 12 FG drain kit) are now widely available and are very effective.…”

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confidence: 99%

Management of spontaneous pneumothorax

Hart

2001

Postgraduate Medical Journal

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“…Some groups [2]advocate conventional chest tube therapy as initial treatment for iatrogenic pneumothorax whereas others advocate the use of simple aspiration [4]or the use of short-term small-calibre tubes [5, 6]. Unfortunately, in up to 25% of cases, simple aspiration will fail [4, 5, 7], and these patients are difficult to identify in advance as the post-aspiration radiograph is not always a reliable indicator of whether the pleural leak remains [4, 8]. Depending on the stage of evolution of the pneumothorax there may be an on-going air leak such that the lung may be deflating at the time of aspiration, or the leak may have closed as a consequence of lung collapse.…”

Section: Introductionmentioning

confidence: 99%

Iatrogenic Pneumothorax: Marker Gas Technique for Predicting Outcome of Manual Aspiration

Kiely

Davey²,

Mahadevan³

et al. 2001

Respiration

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Background: Although manual aspiration is used for treating pneumothorax, the post-aspiration radiograph may not be a reliable indicator of whether the pleural leak remains. We have previously shown that marker gas can identify an air leak in patients with spontaneous pneumothoraces. Objective: This study examines whether a marker gas technique can be safely used to manage patients with iatrogenic pneumothoraces. Methods: 10 patients with iatrogenic pneumothorax were identified among a cohort referred for manual aspiration of pneumothorax, using a marker gas technique, in which inspired metered-dose inhaler propellant gas is detectable in pneumothorax aspirate using a portable flame ioniser. The presence of marker gas was taken to imply a persistent air leak. Results: Marker gas was detected in the aspirate from 3 out of 10 pneumothoraces. 2 required intercostal tube drainage because of lung collapse following initial aspiration and 1 was treated conservatively. Marker gas was not detected in 7 cases (2 post-pacemaker insertion, 5 pleural aspiration ± biopsy), and in all these cases, manual aspiration resulted in sustained re-expansion of the lung. There was a trend towards a significant relationship between the presence or absence of marker gas and the need for a further intervention (p = 0.055). Conclusion: The presence or absence of a pleural leak during manual aspiration of iatrogenic pneumothorax can be demonstrated by this technique. The absence of marker gas in the aspirate implies that manual aspiration will be successful, whereas its presence, in most cases, predicts either failure of manual aspiration to expand the lung or early re-collapse of the lung.

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Role of small calibre chest tube drainage for iatrogenic pneumothorax.

Abstract: A 2 mm Teflon catheter was used

Cited by 35 publications

References 8 publications

Simplified stepwise management of primary spontaneous pneumothorax: a pilot study

Simplified stepwise management of primary spontaneous pneumothorax: a pilot study

Management of spontaneous pneumothorax

Iatrogenic Pneumothorax: Marker Gas Technique for Predicting Outcome of Manual Aspiration

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