Abstract
BackgroundPatients with a primary spontaneous pneumothorax (PSP) who are treated with chest tube drainage are traditionally connected to an analogue chest drainage system, containing a water seal and using a visual method of monitoring air leakage. Electronic systems with continuous digital monitoring of air leakage provide better insight into actual air leakage and changes in leakage over time, which may lead to a shorter length of hospital stay.MethodsWe performed a randomized controlled trial comparing the digital with analogue system, with the aim of demonstrating that use of a digital drainage system in PSP leads to a shorter hospital stay.ResultsIn 102 patients enrolled with PSP we found no differences in total duration of chest tube drainage and hospital stay between the groups. However, in a post-hoc analysis, excluding 19 patients needing surgery due to prolonged air leakage, hospital stay was significantly shorter in the digital group (median 1 days, IQR 1–5 days) compared to the analogue group (median 3 days, IQR 2–5 days) (p 0.014). Treatment failure occurred in 3 patients in both groups; the rate of recurrence within 12 weeks was not significantly different between groups (16% in the digital group versus 8% in the analogue group, p 0.339).ConclusionLength of hospital stay was not shorter in patients with PSP when applying a digital drainage system compared to an analogue drainage system. However, in the large subgroup of uncomplicated PSP, a significant reduction in duration of drainage and hospital stay was demonstrated with digital drainage. These findings suggest that digital drainage may be a practical alternative to manual aspiration in the management of PSP.Trial registrationRegistered 22 September 2013 - Retrospectively registered, Trial NL4022 (NTR4195)
Highlights
Patients with a primary spontaneous pneumothorax (PSP) who are treated with chest tube drainage are traditionally connected to an analogue chest drainage system, containing a water seal and using a visual method of monitoring air leakage
Since it is associated with reduced hospitalization or length of stay (LOS) [8], manual aspiration is recommended as the standard of care in international guidelines and recommendations [5, 13]
In retrospect 6 cases of secondary spontaneous pneumothorax were included (4 in the analogue group and 2 in the digital group); these patients with secondary spontaneous pneumothorax were diagnosed with an underlying pulmonary condition after their hospital admission with pneumothorax
Summary
Patients with a primary spontaneous pneumothorax (PSP) who are treated with chest tube drainage are traditionally connected to an analogue chest drainage system, containing a water seal and using a visual method of monitoring air leakage. The management of PSP is based on two principles: first, the initial management of the pneumothorax with symptom control and re-expansion of the lung and secondly, reducing recurrence rate [4]. Manual aspiration has been shown to be effective in approximately two-thirds of patients [8] and is as effective as chest tube drainage [8]. Since it is associated with reduced hospitalization or length of stay (LOS) [8], manual aspiration is recommended as the standard of care in international guidelines and recommendations [5, 13]. In daily practice, insertion of a small-bore pleural catheter or chest tube is still common practice in the Netherlands, probably due to practical reasons
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