Primary Spontaneous Pneumothoraces Research Articles

Current Management Strategies for Primary Spontaneous Pneumothorax

Primary spontaneous pneumothorax is a distressing condition which affects young healthy patients. In this review, we highlight recent advances in the management of primary spontaneous pneumothorax and look to the future with the advent of studies that will have global impact in the area. Recent research has taken a step back from immediate invasive interventions which can confine a patient to a hospital bed, exploring instead alternative approaches such as ambulatory management or observation. When managing primary spontaneous pneumothoraces acutely, rather than opting for aggressive chest tube drainage, clinicians are encouraged to consider less invasive management options such as conservative observation, aspiration, or insertion of pleural vents. An assessment of the underlying cause of primary spontaneous pneumothorax is essential. Similarly, the clinician must evaluate the risk of recurrence as this influences onward management. In the next few years, we expect further exciting developments emerge that will illuminate these issues further.

TO STUDY THE VARIOUS ETIOLOGICAL FACTORS OF SPONTANEOUS PNEUMOTHORAX AT TERTIARY CARE CENTER JAIPUR, RAJASTHAN, INDIA

Background: Primary spontaneous pneumothoraces (PSP) affect patients who do not have clinically apparent lung disorders. Secondary pneumothoraces occur in the setting of underlying pulmonary disease.
 Methods: A total of 100 patients, including both males and females, admitted during the given period to the hospital with a diagnosis of spontaneous Pneumothorax (SP) were included in the study after applying to the inclusion and exclusion criteria.
 Results: COPD was the most common cause (45.6%) followed by Tuberculosis (30%). Silicosis was seen in 18.9% of SSP cases. Other less common causes were Bronchiectasis (3.3%), Pneumonia (1.1%) and Malignancy (1.1%).
 Conclusion: Secondary spontaneous pneumothorax is far more common than primary spontaneous pneumothoraces and COPD is the predominant underlying cause of secondary spontaneous pneumothorax followed by pulmonary tuberculosis. We also found that silicosis is a significant contributor to secondary spontaneous pneumothorax, after COPD and pulmonary tuberculosis.
 Keywords: COPD, TB, Etiology

P211 Domiciliary care of patients with primary and secondary pneumothoraces: Our experience in Ayrshire, patient satisfaction and health economic analysis

BackgroundDomiciliary care (DC) of Spontaneous Pneumothoraces (SP) with an ambulatory Heimlich Valve (HV) attached to the Intercostal Chest Drain (ICD) has potential for care-closer-to-home, avoiding hospitalisation and saving healthcare resources....

Are Large Primary Spontaneous Pneumothoraces Always a Surgical Alternative?

Are Large Primary Spontaneous Pneumothoraces Always a Surgical Alternative?

Pleural controversy: Aetiology of pneumothorax

Pneumothoraces are classified as spontaneous, traumatic and iatrogenic. Spontaneous pneumothoraces that occur without recognized lung disease are termed primary spontaneous pneumothoraces (PSP), whereas those that occur due to an underlying lung disease are termed secondary spontaneous pneumothoraces. The aetiology of secondary, traumatic or iatrogenic pneumothoraces is not usually debated. However, the aetiology of PSP is potentially controversial and often debated. Therefore, PSP is the focus of this article. There are several purported causes, which include blebs, bullae, emphysema-like changes (ELC) and pleural porosity. The controversy is valid because of the importance of recurrence prevention. This article reviews the current available evidence for the causes of PSP. The causes of PSP are likely a combination ELC, pleural porosity and other potential factors.

Management of Pneumothorax

Pneumothoraces are classified as spontaneous, traumatic, and iatrogenic. Spontaneous pneumothoraces (SPs) occur without recognized lung disease [primary spontaneous pneumothoraces (PSPs)] or due to an underlying lung disease [secondary spontaneous pneumothoraces (SSPs)]. Treatment of PSPs and SSPs has been heterogeneous in the United States. This heterogeneity in management is likely due in part to the fact that the American College of Chest Physicians guidelines and the British Thoracic Society guidelines differ on some management recommendations, including recommendations that pertain to simple aspiration. Traumatic pneumothoraces due to penetrating or nonpenetrating (blunt) trauma usually require the placement of a larger-bore chest tube. Iatrogenic pneumothoraces, most commonly due to transthoracic needle aspiration, may be treated in carefully selected patients with observation. The presence of underlying emphysema in the setting of an iatrogenic pneumothorax usually mandates placement of a drainage catheter.

Comparison of a large and small-calibre tube drain for managing spontaneous pneumothoraces

To compare treatment success of large- and small-bore chest drains in the treatment of spontaneous pneumothoraces the case-notes were reviewed of those admitted to our hospital with a total of 73 pneumothoraces and who were treated by trainee doctors of varying experience. Both a large- and a small-bore intercostal tube drain system were in use during the two-year period reviewed. Similar pneumothorax profile and numbers treated with both drains were recorded, resulting in a similar drain time and numbers of successful and failed re-expansion of pneumothoraces. Successful pneumothorax resolution was the same for both drain types and the negligible tube drain complications observed with the small-bore drain reflected previously reported experiences. However the large-bore drain was associated with a high complication rate (32%) with more infectious complications (24%). The small-bore drain was prone to displacement (21%). There was generally no evidence of an increased failure and morbidity, reflecting poorer expertise, in the non-specialist trainees managing the pneumothoraces. A practical finding however was that in those large pneumothoraces where re-expansion failed, the tip of the drain had not been sited at the apex of the pleural cavity irrespective of the drain type inserted.

RESULTS OF VIDEO ASSISTED THORACOSCOPIC PLEURODESIS IN MANAGEMENT OF PNEUMOTHORACES

The objective of the study is to find out the efficiency of video assisted thoracoscopic (VATS) pleurodesis and predisposing factors of postoperative complications. This is a retrospective study that those who had VATS pleurodesis from January 1994 to December 2000 were recruited. There were consecutive 306 VATS pleurodesis performed on 271 patients. These included 33 female and 238 male patients from 15 to 73 years old. 31 of them had bilateral procedures. 244 of them had primary spontaneous pneumothoraces and 27 of them had secondary pneumothoraces. Most of them had two or more episodes of pneumothoraces and persistent air leakage >14 days before operations. 15 patients had failed surgical or chemical pleurodesis before VATS. There was no operative death. Usually they were discharged within five days after operations. There were 21 persistent air leakage >5 days (6.8%), 1 bleeding required surgical haemostasis (0.3%) and 4 infectious complications (1.3%). Follow up duration was up to 72 months. There was 12 recurrence (3.9%) after discharge. Absence of blebs, presence of pleural adhesion, prolonged chest tube placement before VATS pleurodesis, and failed surgical or chemical pleurodesis before are the predisposing factors of complications.

The Long-term Follow-up Study of Therapeutic Effects of 8 French Catheter for Spontaneous Pneumothorax

Background : Spontaneous pneumothoraces(SP) are divided into primary spontaneous pneumothoraces (PSP) which develop in healthy individuals without underlying pulmonary disorders and secondary spontaneous pneumothoraces(SSP) which occur in those who have underlying disorders such as tuberculosis or chronic obstructive lung diseases. Yet there is no established standard therapeutic approach to this disorder, i.e., from the spectrum of noninvasive treatment such as clinical observation with or without oxygen therapy, to aggressively invasive thoracoscopic bullectomy or open thoracotomy. Although chest tube thoracostomy has been most widely used, the patients should overcome pain in the initiation of tube insertion or during indwelling it potential infection and subcutaneous emphysema. Thus smaller-caliber tube has been challenged for the treatment of pneumothorax. Previously, we studied the therapeutic efficacy of 8 French catheter for spontaneous pneumothorax. But there has been few data for effectiveness of small-caliber catheterization in comparison with that of chest tube. In this study, we intended to observe the long-term effectiveness of 8 French catheter for the treatment of spontaneous pneumothoraces in comparison with that of chest tube thoracostomy. Method : From January, 1990 to January, 1996, sixty two patients with spontaneous pneumothoraces treated at Chung-Ang University Hospital were reviewed retrospectively. The patients were sub-divided into a group treated with 8 French catheter(n=23) and the other one with chest tube insertion(n=39). The clinical data were reviewed(age, sex, underlying pulmonary disorders, past history of pneumothorax, size of pneumothorax, follow-up period). And therapeutic effect of two groups was compared by treatment duration(duration of indwelling catheter or tube), treatment-associated complications and recurrence rate. Results : The follow-up period(median) of 8 French catheter group and chest tube group was 28 and 22 months, which had no statistical significance. Ther was no statistically significant difference of clinical characteristics between two groups with SP, PSP, SSP. The indwelling time of 8 French catheter group was days, which was significantly shorter than that of chest tube group in SP, days(p=0.047). In comparison of treatment-related complication in PSP, 8 French catheter group as 6.25% of complication showed lower tendency than the other group as 23.8% (p=0.041 ; one-tailed, p=0.053; two-tailed). The recurrence rate in each group of SP was 17.4%, 10.3%, which did not show any statistically significant difference. Conclusion : Treatment with 8 French catheter resulted in shorter indwelling time in sponteous pneumothorax, and lower incidence of treatment-related complication in primary spontaneous pneumothorax. And the recurrence rate in each of treatment group showed no statistically significant difference. So, we can recommend the 8 French small-caliber catheter for the initial therapy for spontaneous pneumothorax for the replacement of conventional chest tube thoracostomy. But further prospective study with more subjects of spontaneous pneumothorax will be needed for the evaluation of effectiveness of 8 French cateter.