Spontaneous pneumothorax: use of aspiration and outcomes of management by respiratory and general physicians

Abstract

Background: Spontaneous pneumothorax is a common problem in hospital practice. Despite the publication of guidelines controversy over its initial management still exists, particularly over the use of simple aspiration. Methods: The management of spontaneous pneumothorax by respiratory and general physicians at our hospital was analysed by retrospective case note review. Eighty five patients were identified over the study period (36 managed by respiratory and 49 by general physicians).Results: There was a significantly greater use of simple aspiration by respiratory (81%) than general physicians (47%, p<0.001) and a higher rate of success in this group. As a result those patients managed by respiratory physicians had fewer intercostal drains inserted and significantly shorter length of stays (mean 5.6 (3.8) days respiratory group and 9.5 (6.8) days in general physicians group, p<0.05). Conclusions:The greater and more successful use of simple aspiration by respiratory physicians as an initial treatment for spontaneous pneumothorax resulted in improved outcomes and reduced length of hospital stays.

Simple aspiration as initial treatment for primary spontaneous pneumothorax: Results of 91 consecutive cases

“…Only 27 patients who had undergone simple aspiration were studied, and the authors conceded that statistical power was insufficient to formally confirm therapeutic equality. Similarly, most other previous studies or series were small, each including only around 30 -40 patients or less who had undergone the procedure (17,18,(22)(23)(24)(25)(26)(27). Andrivet and colleagues published a study involving a total of 68 patients in two protocols (28).…”

“…The reported success rate of simple aspiration of spontaneous pneumothorax ranged from 34% to 93% (17,18,(22)(23)(24)(25)(26)(27)(28). This wide variation may be due to differences in the characteristics of included patients, differences in the definition of success, whether or not reaspiration was performed, and differences in the duration of follow-up.…”

“…Compared to chest tube drainage, the potential advantage of simple aspiration is reduced hospital admission rate and reduced length of stay, translating into economic saving benefits (17,18). Simple aspiration is also a less painful procedure.…”

The Role of Simple Aspiration in the Management of Primary Spontaneous Pneumothorax

“…The technique described in the guidelines, still practiced today, involved the use of a 16-gauge cannula under local anesthetic at the second intercostal space, mid-clavicular line, with a 50-mL syringe and a three-way tap (or stopcock). Compared to chest tube drainage, the advantages of simple aspiration are reduced hospital admission rate and reduced length of stay, translating into economic costsaving benefits (22,23). It is also a less painful procedure.…”

Ambulatory management of primary spontaneous pneumothorax: the good is (not always) the enemy of the better (evidence)

“…The outcome of a treatment algorithm might also be influenced by the medical background of the treating physician. PACKHAM and JAISWAL [11], for instance, demonstrated that patients with PSP managed by respiratory physicians had, overall, fewer intercostal drains inserted and a significantly shorter length of hospital stay than those managed by nonrespiratory physicians.…”