Safety and efficacy of ambulatory management of secondary spontaneous pneumothorax: a case series

Abstract

IntroductionThe optimal management of pneumothorax remains undefined. There is a growing consensus that patients with spontaneous pneumothorax can be considered for ambulatory management with the use of a one-way valve. Despite this, there is little data on the outcomes of outpatient management of secondary spontaneous pneumothorax (SSP).MethodsAt our institution, selected patients with primary and secondary spontaneous pneumothorax who meet the predefined local criteria are managed on an ambulatory pathway. We prospectively evaluated our practice over a 3-year period and explore outcomes of patients with SSP using primary spontaneous pneumothorax (PSP) as a comparator group.Results163 consecutive patients presenting to our hospital between September 2014 and July 2017 were evaluated using a predefined protocol. 111 (49 SSP and 62 PSP) were deemed suitable for outpatient management. Resolution on day 5 was similar between the two groups (65% in the SSP vs 79% in the PSP group; p=0.108). The mean drainage time was 5.84 days in SSP compared with 5.69 days in PSP, representing a difference of 0.15 days (95% CI −2.47 to 2.16; p=0.897). Complications such as infection and drain blockage/falling-out were scarce, with comparable pain and satisfaction scores across both groups. There were no deaths during this period. An estimated £86 796 ($113 920) was saved over the study period, equating to £1118.80 ($1550) per patient.DiscussionThis study suggests that outpatient management of selected patients with SSP may be effective, safe and cost-saving.

Ambulatory management of secondary spontaneous pneumothorax: a randomised controlled trial

“…The review cited high rates of success in patients with SSP, defined as use of a flutter valve with a chest tube to manage pneumothorax. A subsequently published prospective case series of a selected cohort of patients with SSP reported that 65% (32/49) were successfully managed with the AP attached to a 12F chest drain [12]. However, non-randomised case-series are subject to high risk of selection bias, with sick and complex patients at greater risk of exclusion.…”

New insights into spontaneous pneumothorax: A review

“…The one study had a success rate of 79% in patients with large pneumothoraces and 37% had full outpatient management, [46] while the other study found that ambulatory management can be effective even in patients with overt underlying lung disease with a mean drainage time of 5.84 days. [47] Both studies found that this method was associated with reduced hospital costs and avoided potential tension pneumothoraces. In a situation where a patient has ready access to transport and is close to the treating healthcare facility, ambulatory management may be an appropriate strategy.…”

Effectiveness and failure factors of manual aspiration using a small needle for large pneumothorax in stable patients

“…A large bore chest tube drainage and regular inpatient admission are becoming less of the primary strategies for treating primary spontaneous pneumothorax (PSP). Therefore, the current controversy centers on three competing evidence-based options for ambulatory management of large pneumothoraces: watchful waiting (20,22,23) vs. 16-gaude (G) needle aspiration (7)(8)(9)(10)(12)(13)(14)(15)(16) vs. thoracic vent with an 8-11 French tube (21,(24)(25)(26)(27)(28). These reports indication are mainly for PSP, but other pneumothorax is well unknown.…”