Abstract
BackgroundIn spontaneous pneumothorax, clamping the chest drain before its removal may avoid reinsertion in case of early recurrence, but may be unsafe and may prolong hospital stay. The objective of this study was to examine the incidence of early recurrence in both clamped and unclamped pneumothorax episodes, and factors associated with it.MethodsRetrospective chart review of primary and secondary spontaneous pneumothorax episodes in which chest drain was inserted during the period April 2012 to March 2014.ResultsData of 122 episodes were analysed. There were 36 primary pneumothorax and 86 secondary pneumothorax episodes. Mean age was 59 years with 92% males. Clamping of the chest drain was done in 68 episodes (55.7%), and not done in 54. The clamping group was significantly younger, had more primary pneumothorax, and had shorter time from cessation of air leak to clamp/removal. Recurrence within 24 h were seen in 12 (17.6%) clamped episodes and 4 (7.4%) non-clamped episodes, although in only eight episodes were reinsertion of chest drain saved. Significantly more previous pneumothorax episodes were seen in the early recurrence group. We observed no new onset of tension pneumothorax or subcutaneous emphysema associated with clamping.ConclusionThe practice of clamping the chest drain before removal in spontaneous pneumothorax appear safe. Clamping saved chest drain reinsertion in 11.8% of cases, and has the potential to save more if clamped for up to 24 h. However, clamping may result in more early recurrences. Prospective randomised studies are needed.
Highlights
In spontaneous pneumothorax, clamping the chest drain before its removal may avoid reinsertion in case of early recurrence, but may be unsafe and may prolong hospital stay
Spontaneous pneumothoraces is further sub-divided into primary spontaneous pneumothorax and secondary spontaneous pneumothorax based on whether there is identifiable
Chest drain insertion is indicated for tension pneumothorax, bilateral pneumothorax, those with breathlessness, and those with failed needle aspiration [2]
Summary
In spontaneous pneumothorax, clamping the chest drain before its removal may avoid reinsertion in case of early recurrence, but may be unsafe and may prolong hospital stay. Chest drain insertion is indicated for tension pneumothorax, bilateral pneumothorax, those with breathlessness, and those with failed needle aspiration [2]. Removal of the chest tube is indicated when the lung is fully expanded with no evidence of ongoing air leak. Some clinicians would remove the chest drain right away, and if pneumothorax recurs reinsertion of chest drain is done. Others prefer to clamp the chest drain and observe for a certain period of time. The rationale for this approach is that if pneumothorax recurs the chest drain can be unclamped.
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