Simple aspiration versus intercostal tube drainage for primary spontaneous pneumothorax in adults

Wakai, Abel; O’Sullivan, Ronan; McCabe, Gráinne

doi:10.1002/14651858.cd004479.pub2

Cited by 49 publications

(26 citation statements)

References 34 publications

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“…Although blinding was not secured in all studies considering the characteristics of the offered treatment, we believe that it probably did not lead to performance bias or detection bias. Among the three previous systematic reviews on the same topic, the study by Wakai et al[10] assessed only the risk of bias regarding randomisation and blinding, and other studies used other tools for assessment [9,11]. Thus, comparing their results with ours was not fully applicable.…”

Section: Discussionmentioning

confidence: 84%

Systematic review and meta-analysis of initial management of pneumothorax in adults: Intercostal tube drainage versus other invasive methods

Kim

Park

et al. 2017

PLoS ONE

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ObjectivesThe ideal invasive management as initial approach for pneumothorax (PTX) is still under debate. The purpose of this systematic review and meta-analysis was to examine the evidence for the effectiveness of intercostal tube drainage and other various invasive methods as the initial approach to all subtypes of PTX in adults.MethodsThree databases were searched from inception to May 29, 2016: MEDLINE, EMBASE, and the Cochrane CENTRAL. Randomised controlled trials that evaluated intercostal tube drainage as the control and various invasive methods as the intervention for the initial approach to PTX in adults were included. The primary outcome was the early success rate of each method, and the risk ratios (RRs) were used for an effect size measure. The secondary outcomes were recurrence rate, hospitalization rate, hospital stay, and complications.ResultsSeven studies met our inclusion criteria. Interventions were aspiration in six studies and catheterization connected to a one-way valve in one study. Meta-analyses were conducted for early success rate, recurrence rate, hospitalization rate, and hospital stay. Aspiration was inferior to intercostal tube drainage in terms of early success rate (RR = 0.82, confidence interval [CI] = 0.72 to 0.95, I2 = 0%). While aspiration and intercostal tube drainage showed no significant difference in the recurrence rate (RR = 0.84, CI = 0.57 to 1.23, I2 = 0%), aspiration had shorter hospital stay than intercostal tube drainage (mean difference = -1.73, CI = -2.33 to -1.13, I2 = 0%). Aspiration had lower hospitalization rate than intercostal tube drainage, but marked heterogeneity was present (RR = 0.38, CI = 0.19 to 0.76, I2 = 85%).ConclusionAspiration was inferior to intercostal tube drainage in terms of early resolution, but it had shorter hospital stay. The recurrence rate of aspiration and intercostal tube drainage did not differ significantly. The efficacy of catheterization connected to a one-way valve was inconclusive because of the small number of relevant studies.(Registration of study protocol: PROSPERO, CRD42016037866)

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Section: Discussionmentioning

confidence: 84%

Systematic review and meta-analysis of initial management of pneumothorax in adults: Intercostal tube drainage versus other invasive methods

Kim

Park

et al. 2017

PLoS ONE

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“…A recent evidence-based medicine (EBM) review found no significant difference between simple aspiration and intercostal tube drainage with regard to immediate success rate, early failure rate, duration of hospitalization, one-year success rate, and number of patients requiring pleurodesis at one year. Simple aspiration does not require hospitalization, compared with intercostal tube drainage (Wakai et al, 2007;Zehtabchi and Rios, 2008).…”

Section: Diagnostic Approaches To Pspmentioning

confidence: 99%

Diagnosis and treatment of primary spontaneous pneumothorax

Luh

2010

J. Zhejiang Univ. Sci. B

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Primary spontaneous pneumothorax (PSP) commonly occurs in tall, thin, adolescent men. Though the pathogenesis of PSP has been gradually uncovered, there is still a lack of consensus in the diagnostic approach and treatment strategies for this disorder. Herein, the literature is reviewed concerning mechanisms and personal clinical experience with PSP. The chest computed tomography (CT) has been more commonly used than before to help understand the pathogenesis of PSP and plan further management strategies. The development of video-assisted thoracoscopic surgery (VATS) has changed the profiles of management strategies of PSP due to its minimal invasiveness and high effectiveness for patients with these diseases.

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“…Various thoracostomy techniques by pneumothorax size are introduced in recent studies 17-19. However, we used single size tube in order to exclude decompression pressure variation by diameter of pleural opening.…”

Section: Discussionmentioning

confidence: 99%

The Frequency of Reexpansion Pulmonary Edema after Trocar and Hemostat Assisted Thoracostomy in Patients with Spontaneous Pneumothorax

Cha

Kim

Ji³

et al. 2013

Yonsei Med J

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PurposeSeveral risk factors for development of reexpansion pulmonary edema (REPE) after drainage of pneumothoraces have been reported, but the association between the method of thoracostomy and the development of REPE is unknown. The aim of this study was to compare the frequency of REPE after treatment of spontaneous pneumothorax with trocar or hemostat assisted closed thoracostomy.Materials and MethodsWe performed a prospective, observational study including 173 patients with spontaneous pneumothorax who visited the emergency department from January 2007 to December 2008. In 2007, patients were treated with hemostat-assisted drainage, whereas patients in 2008 were treated with trocar-assisted drainage. The main outcome was the development of REPE, determined by computed tomography of the chest 8 hours after closed thoracostomy. Outcomes in both groups were compared using univariate and multivariate analyses.ResultsNinety-two patients were included, 48 (42 males) of which underwent hemostat-assisted drainage and 44 (41 males) underwent trocar-assisted drainage. The groups were similar in mean age (24±10 vs. 26±14 respectively). The frequencies of REPE after hemostat- and trocar-assisted drainage were 63% (30 patients) and 86% (38 patients) respectively (p=0.009). In multivariate analysis, trocar-assisted drainage was the major contributing factor for developing REPE (odds ratio=5.7, 95% confidence interval, 1.5-21). Age, gender, size of pneumothorax, symptom duration and laboratory results were similar between the groups.ConclusionClosed thoracostomy using a trocar is associated with an increased risk of REPE compared with hemostat-assisted drainage in patients with spontaneous pneumothorax.

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Simple aspiration versus intercostal tube drainage for primary spontaneous pneumothorax in adults

Cited by 49 publications

References 34 publications

Systematic review and meta-analysis of initial management of pneumothorax in adults: Intercostal tube drainage versus other invasive methods

Systematic review and meta-analysis of initial management of pneumothorax in adults: Intercostal tube drainage versus other invasive methods

Diagnosis and treatment of primary spontaneous pneumothorax

The Frequency of Reexpansion Pulmonary Edema after Trocar and Hemostat Assisted Thoracostomy in Patients with Spontaneous Pneumothorax

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