The Dutch Pneumothorax Study: analogue versus digital drainage in PSP, a randomized trial

Abstract

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. Electronic systems with continuous digital monitoring of air leakage provide better insight into actual air leakage and changes in time, which potentially leads to a shorter hospital stay. We performed a randomized controlled trial comparing the digital with analogue system. In 102 patients enrolled with PSP we found no differences in total duration of chest tube drainage and hospital stay between the groups. Clinically relevant recurrence within twelve weeks occurred in 20% of patients in the analogue group versus 14% of patients in digital group, which was not a statistically significant difference. We defined a subgroup of uncomplicated pneumothorax subjects (n=83) which included patients without prolonged air leakage, thus those patients who did not need additional interventions like thoracoscopic pleurodesis or pleurectomy. In this subgroup a statistically significant decrease in duration of chest tube drainage was observed and therefore hospital stay was significantly shortened in the digital group (median 1 day versus 3 days in the analogue group). We conclude that in the subgroup of patients with PSP who could be treated with drainage only (uncomplicated PSP), digital drainage might be helpful in shortening hospital stay.