Management Of Secondary Spontaneous Pneumothorax Research Articles

Early Outcomes of video-assisted thoracoscopic management of secondary spontaneous pneumothorax

Early Outcomes of video-assisted thoracoscopic management of secondary spontaneous pneumothorax

Conservative versus invasive management of secondary spontaneous pneumothorax: a retrospective cohort study.

AimHospitalization, often with intervention, is the recommended management algorithm by multiple international respiratory societies for management of a secondary spontaneous pneumothorax (SSP). Over recent years we adopted a conservative approach to SSPs. We undertook a retrospective cohort study of SSP to establish the safety profile of a conservative approach for these previously unstudied patients.MethodsWe reviewed all cases of SSP presenting to our institution from 2012 to 2019 using the 2010 British Thoracic Society definition of an SSP. Age, gender, smoking status, underlying lung disease, pneumothorax size estimate (using the Collins method), nature of intervention, inpatient duration, and any additional complications were recorded. The χ2‐test and Mann–Whitney U‐test were used for comparison of categorical variables and categorical/continuous variables, respectively.ResultsEighty‐two cases were included in the final analysis. Of them, 64 had an interpleural distance at the hilum of 1cm or greater, meeting British Thoracic Society criteria for a pleural intervention. Of these 64 patients, 25 (39%) were managed conservatively. No patient managed conservatively required a subsequent intervention. When stratified for conservative or invasive management, there was no significant difference in age, gender, smoking status, or presence of underlying lung disease between the groups. There was a significant difference in size of the pneumothorax with conservative management having smaller pneumothoraces (37% versus 54%, P < 0.001) and a shorter inpatient stay (conservative, 7.9 days; intercostal catheter, 9 days; P = 0.004).ConclusionWe have demonstrated success with conservative management of SSPs where a significant proportion of them met accepted criteria for a pleural intervention.

Ambulatory management of secondary spontaneous pneumothorax: a randomised controlled trial.

Secondary spontaneous pneumothorax (SSP) is traditionally managed with an intercostal chest tube attached to an underwater seal. We investigated whether use of a one-way flutter valve shortened patients' length of stay (LoS).This open-label randomised controlled trial enrolled patients presenting with SSP and randomised to either a chest tube and underwater seal (standard care: SC) or ambulatory care (AC) with a flutter valve. The type of flutter valve used depended on whether at randomisation the patient already had a chest tube in place: in those without a chest tube a pleural vent (PV) was used; in those with a chest tube in situ, an Atrium Pneumostat (AP) valve was attached. The primary end-point was LoS.Between March 2017 and March 2020, 41 patients underwent randomisation: 20 to SC and 21 to AC (13=PV, 8=AP). There was no difference in LoS in the first 30 days following treatment intervention: AC (median=6 days, IQR 14.5) and SC (median=6 days, IQR 13.3). In patients treated with PV there was a high rate of early treatment failure (6/13; 46%), compared to patients receiving SC (3/20; 15%) (p=0.11) Patients treated with AP had no (0/8 0%) early treatment failures and a median LoS of 1.5 days (IQR 23.8).There was no difference in LoS between ambulatory and standard care. Pleural Vents had high rates of treatment failure and should not be used in SSP. Atrium Pneumostats are a safer alternative, with a trend towards lower LoS.

Safety and efficacy of ambulatory management of secondary spontaneous pneumothorax: a case series

IntroductionThe optimal management of pneumothorax remains undefined. There is a growing consensus that patients with spontaneous pneumothorax can be considered for ambulatory management with the use of a one-way valve....

Prise en charge des pneumothorax chez les fumeurs de cannabis : à propos de trois cas

Cannabis consumption is common among adolescents and young adults in France. In addition to its neurological effect, cannabis smoking can induce severe pulmonary emphysema, even in young patients. When a spontaneous pneumothorax occurs in a cannabis smoker, the possibility of a secondary spontaneous pneumothorax should be considered. This may be of importance as management of secondary spontaneous pneumothorax may differ from the well-codified handling of primary spontaneous pneumothorax. Clinical and radiological data from three young cannabis-using patients with spontaneous pneumothorax were collected. Given the presence of emphysema, they were all considered secondary spontaneous pneumothorax. Two patients underwent surgical treatment, with simple postoperative follow-up in one case and prolonged air leak in the other case. The management of the third patient, exclusively medical, was prolonged and complicated. The presence of emphysema in young cannabis smokers complicates the management of spontaneous pneumothorax. In this context, a first-line surgical intervention may be an option to be considered.

Study of pigtail catheter and chest tube in management of secondary spontaneous pneumothorax

BackgroundThe initial management for a large and symptomatic secondary spontaneous (SSP) pneumothorax is to remove the air from the pleural space, but recommended methods varied across guidelines, from a large bored chest tube toward less invasive management with the use of smaller catheters. So the aim of this study is to elucidate the effectiveness, safety and tolerability of small bore catheter in draining (SSP). Patients and methodsThis study is a prospective randomized controlled trial (RCT) which was carried out at Chest Department, Zagazig University Hospitals and included 22 patients with SSP. The cases were enrolled into the study according to the following criteria: first episode of SSP, large size pneumothorax, SSP with circulatory and respiratory distress (tension pneumothorax) irrespective of the size of pneumothorax. The patients were randomly assigned into two groups into: test group including 11 patients who underwent small bore pigtail catheter drainage (14 Fr) and a control group including 11 patients who underwent conventional large bore chest tube drainage (30 Fr). Follow up of patients and extubation after resolution of pneumothorax was applied. Success of drainage was considered with full lung reexpansion and extubation with hospital discharge. ResultsThe frequency of success rate in the pigtail group and ICT group is nearly comparable (72.7%) and (63.6%) without significant difference. The frequency of complications following SSP drainage in patients of both studied groups was 36.7%. The more frequent complications among the failed cases was tube displacement and sepsis followed by surgical emphysema. The frequency of drainage complications was more frequent in failed cases of ICT than failed cases of the pigtail group with a significant difference. Among patients with successful outcome, pigtail catheter drainage of SSP was associated with significant and highly significant reduction in drainage duration and length of hospital stay in comparison to ICT drainage. ConclusionPigtail catheter drainage is nearly effective as ICT drainage of first episode of SSP. Pigtail catheter offers a safe, tolerable method for draining SSP with a shorter duration of drainage and hospital stay more than ICT. Increasing BMI is associated with drainage failure of SSP, where obesity is considered as a risk factor with high specificity for pigtail catheter drainage failure.

Influence of old pulmonary tuberculosis on the management of secondary spontaneous pneumothorax in patients over the age of 70 years.

This study aimed to investigate the treatment outcomes and influence of old pulmonary tuberculosis (TB) in elderly patients (over 70 years) with secondary spontaneous pneumothorax (SSP). A retrospective analysis was performed on patients with SSP between January 2002 and December 2014. Treatment outcomes including chest tube duration (CTD), type and complication of surgery, recurrence and survival rate were obtained from the review of medical records and analyzed statistically. Two hundred and sixteen consecutive cases were recruited. Of these, 134 (62.0%) did not have old pulmonary TB [non-tuberculosis (NTB) group], and the other 82 (38.0%) had experienced pulmonary TB (TB group). More thoracoscopic surgeries had been performed in the NTB group (P=0.038). More postoperative complications developed in the TB group (P=0.038). Total CTD and postoperative CTD in the TB group were significantly longer (P=0.015 and 0.030, respectively). However, recurrence-free survival and overall survival rate were not significantly different between the TB and NTB groups. Old pulmonary TB in elderly patients with SSP made their treatment more complicated. However, surgery might be considered in highly selected patients regardless of old pulmonary TB, and could be conducted with acceptable morbidity and mortality.

Non-intubated video-assisted thoracic surgery management of secondary spontaneous pneumothorax.

Secondary spontaneous pneumothorax (SSP) is serious entity, usually due to underlying disease, mainly chronic obstructive pulmonary disease (COPD). Its morbidity and mortality is high due to the pulmonary compromised status of these patients, and the recurrence rate is almost 50%, increasing mortality with each episode. For persistent or recurrent SSP, surgery under general anesthesia (GA) and mechanical ventilation (MV) with lung isolation is the gold standard, but ventilator-induced damages and dependency, and postoperative pulmonary complications are frequent. In the last two decades, several groups have reported successful results with non-intubated video-assisted thoracic surgery (NI-VATS) with thoracic epidural anesthesia (TEA) and/or local anesthesia under spontaneous breathing. Main benefits reported are operative time, operation room time and hospital stay reduction, and postoperative respiratory complications decrease when comparing to GA, thus encouraging for further research in these moderate to high risk patients many times rejected for the standard regimen. There are also reports of special situations with satisfactory results, as in contralateral pneumonectomy and lung transplantation. The aim of this review is to collect, analyze and discuss all the available evidence, and seek for future lines of investigation.

中高年の続発性自然気胸に対するシリコンドレーン（BLAKEドレーン）による胸腔ドレナージ

中高年の続発性自然気胸に対するシリコンドレーン（BLAKEドレーン）による胸腔ドレナージ

Surgical Management of Secondary Spontaneous Pneumothorax in Elderly Patients with Chronic Obstructive Pulmonary Disease: Retrospective Study of 107 Cases

Aim of the study was to assess the results of surgery for secondary spontaneous pneumothorax (SSP) in the elderly with COPD at Shanghai Pulmonary Disease Hospital. From 1 January 1993 to 30 June 2007, the operation for SSP was performed in 107 elderly patients (> or = 60y) with COPD. All patient data was reviewed retrospectively. Morbidity was 25.2 % and mortality was 4.7 %. The total effective rate of intrapleural injection of human fibrinogen for the treatment of postoperative persistent air leaks was 86.7 %. Multivariate analyses of postoperative air leaks suggest that patients undergoing pleurodesis (OR 0.189, 95 % CI 0.045-0.790, P = 0.022) have a decreased risk of postoperative air leaks. Multivariate analyses of postoperative complications suggest that patients with higher PaCO (2) (OR 0.890, 95 % CI 0.814-0.973, P = 0.011) have an increased risk and patients undergoing pleurodesis (OR 4.319, 95 % CI 1.398-13.349, P = 0.011) have a decreased risk. Surgical intervention is recommended in selected elderly COPD patients with SSP, with hypercapnia known as an operative contraindication. Additionally, surgery offers the advantage of intraoperative pleurodesis for the prevention of prolonged postoperative air leaks, while intrapleural injection of human fibrinogen is an effective procedure in the treatment of air leaks.

Pigtail catheter drainage for secondary spontaneous pneumothorax

Sir, Several treatments are recommended for a first episode of primary spontaneous pneumothorax (PSP), including simple observation, oxygen supplementation, simple aspiration and chest tube drainage, depending on the severity of pneumothoraces. 1 However, management for secondary spontaneous pneumothorax (SSP) remains problematic, because of the lack of universally accepted management guidelines. Previously, we reported our experience in treating PSP using pigtail tube drainage and the results were promising.2 However, it is still not known whether the pigtail catheter is effective in the management of SSP. We now report our experience and results using the pigtail catheter in the treatment of SSP over a 3-year period. From July 2002 to July 2005, 64 patients with a first episode of SSP treated at the China Medical University Hospital were included in our series: 52 males (81%) and 12 females (19%). The age range was 17–91 years, mean ± SD 59.5 ± 19.0. A chest ultrasound examination was performed first for guidance; then the pigtail catheter (10 …