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

Abstract

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)

Chest tube drainage versus needle aspiration for primary spontaneous pneumothorax: which is better?

“…Secondly, we performed strict inclusion and exclusion criteria. Kim et al's research (62), which published in 2017, didn't differentiate PSP and SSP without any subgroup analyses. While we researched on PSP but SSP, and included one recent study published in this year.…”

Does the Chest Tube Removal Time Influence the Outcomes of Primary Spontaneus Pneumothorax First Episode Management?

“…The main goals in the management of PSP are to re-expand the lung and prevent recurrence, with minimal morbidity [19]. There are different therapeutic options described in literature for managing PSP: observation, air aspiration, placement of the chest tube, pleurodesis, thoracoscopy, and thoracotomy [20][21][22]. Chest tube drainage still remains the main option to manage the first episode of PSP.…”

“…There is a hypothesis that chest tube may irritate the pleural surface and may work like mechanical pleurodesis [14,30,31]. This probably could explain findings in some studies which showed that the recurrence rate after conservative management (without any intervention or only needle aspiration) is higher comparing to chest tube drainage [14,21,22,27].…”

Indications of Surgery in Pneumothorax

“…Simple needle aspiration was associated with a reduction in the percentage of patients hospitalized when comparing it with intercostal tube insertion. Again, another recent meta-analysis by Kim and his colleagues [10] comparing seven studies for initial management of primary spontaneous pneumothorax showed that the recurrence rate of aspiration and intercostal tube drainage did not differ significantly, and again NA was associated with a shorter hospital patient stay. NA was however associated with inferior results regarding early resolution of pneumothorax in comparison to CTD.…”