Pneumothorax Therapy Research Articles

Two-port versus three-port video-assisted thoracoscopic surgery for primary spontaneous pneumothorax: feasibility, postoperative outcome and long-term recurrence rates

BackgroundTwo-port VATS (2-P-VATS) and three-port VATS (3-P-VATS) are well-established techniques for surgical therapy of primary spontaneous pneumothorax (PSP). However, comparisons of both techniques in terms of postoperative outcome and recurrence are limited.MethodsFrom January 2010 to March 2020, we retrospectively reviewed data of 58 PSP patients who underwent VATS in our institution. For statistical analysis, categorical and continuous variables were compared by chi-square test or Fisher’s exact test and the Student´s t-test, respectively. Twenty-eight patients underwent 2-P-VATS and 30 were treated with 3-P-VATS. Operation time, length of hospital stay (LOS), total dose of analgesics per stay (opioids and non-opioids), duration of chest tube drainage, pleurectomy volume (PV), postoperative complications and recurrence rates were compared between both groups.ResultsClinical and surgical characteristics including mean age, gender, Body-Mass-Index (BMI), pneumothorax size, smoking behaviour, history of contralateral pneumothorax, side of pneumothorax, pleurectomy volume and number of resected segments were similar in both groups. The mean operation time, LOS and total postoperative opioid and non-opioid dose was significantly higher in the 3-P-VATS group compared with the 2-P-VATS group. Despite not being statistically significant, duration of chest tube was longer in the 3-P-VATS group compared with the 2-P-VATS group. In terms of postoperative complications, the occurrence of hemothorax was significantly higher in the 3-P-VATS group (3-P-VATS vs. 2-P-VATS; p = 0.001). During a median follow-up period of 61.6 months, there was no significant statistical difference in recurrence rates in both groups (2/28 (16.7%) vs. 5/30 (7.1%); p = 0.274).ConclusionOur data demonstrate that 2-P-VATS is safer and effective. It is associated with reduced length of hospital stay and decreased postoperative pain resulting in less analgesic use.

Prospective study of aspiration therapy for primary spontaneous pneumothorax

Prospective study of aspiration therapy for primary spontaneous pneumothorax

Clinico-radiological profile and outcome of patients undergoing intercostal tube drainage in a tertiary care hospital in West Bengal, India

Introduction: Evacuation of empyema which was first performed centuries ago, marked the beginning of thoracic drainage. The subsequent acquisition of a greater knowledge of the anatomy, physiology, and pathology of the pleural space directed the design of thoracic catheters and drainage systems and the development of the methods by which they are used. Thoracic drainage systems are designed to remove air and liquids from the pleural space or mediastinum, which collect there as a result of injury, disease, or surgical procedures. Method: A total of 100 patients who underwent intercostal tube drainage due to various etiologies are followed up for 3 months in the study Results: In this study it was observed that pneumothorax (67%) as the most common indication for chest drain insertion followed by hydro-pneumothorax. During this period 100 patients of different pathologies related to chest underwent chest intubations. Amongst them 88(88%) were male and 12(12%) were female. Subcutaneous emphysema was found to be the most common complication followed by ICD tube blockage. Among the study population 95% patients were successfully treated & unsuccessful outcome was only 5%. Conclusion: Chest tube insertion is a common procedure usually done for the purpose of draining accumulated air or fluid in the pleural cavity. Small-bore chest tubes (≤14F) are generally recommended as the first-line therapy for spontaneous pneumothorax in non-ventilated patients and pleural effusions in general. Large-bore chest drains may be useful for very large air leaks, as well as post-ineffective trial with small-bore drains.

The analysis of simple aspiration therapy for pneumothorax using machine learning

The analysis of simple aspiration therapy for pneumothorax using machine learning

Management of Spontaneous Pneumothorax and Postinterventional Pneumothorax: German S3-Guideline.

Based on the source guideline of the British Thoracic Society (BTS2010) for spontaneous pneumothorax, a literature search on spontaneous pneumothorax was carried out from 2008 onwards, for post-interventional pneumothorax from 1960 onwards. Evidence levels according to the Oxford Center for Evidence-Based Medicine (2011) were assigned to the relevant studies found. Recommendations according to GRADE (A: "we recommend"/"we do not recommend", B: "we suggest"/"we do not suggest") were determined in three consensus conferences by the nominal group process. The algorithms for primary and secondary pneumothorax differ in the indication for CT scan as well as in the indication for chest drainage application and video-assisted thoracic surgery (VATS). Indication for surgery is recommended individually taking into account the risk of recurrence, life circumstances, patient preferences and procedure risks. For some forms of secondary pneumothorax, a reserved indication for surgery is recommended. Therapy of postinterventional spontaneous pneumothorax is similar to that of primary spontaneous pneumothorax. The recommendations of the S3 Guideline provide assistance in managing spontaneous pneumothorax and post-interventional pneumothorax. Whether this will affect existing deviant diagnostic and therapeutic measures will be demonstrated by future epidemiological studies.

Chest Tube Drainage of the Pleural Space: A Concise Review for Pulmonologists

Chest tube insertion is a common procedure usually done for the purpose of draining accumulated air or fluid in the pleural cavity. Small-bore chest tubes (≤14F) are generally recommended as the first-line therapy for spontaneous pneumothorax in non-ventilated patients and pleural effusions in general, with the possible exception of hemothoraces and malignant effusions (for which an immediate pleurodesis is planned). Large-bore chest drains may be useful for very large air leaks, as well as post-ineffective trial with small-bore drains. Chest tube insertion should be guided by imaging, either bedside ultrasonography or, less commonly, computed tomography. The so-called trocar technique must be avoided. Instead, blunt dissection (for tubes >24F) or the Seldinger technique should be used. All chest tubes are connected to a drainage system device: flutter valve, underwater seal, electronic systems or, for indwelling pleural catheters (IPC), vacuum bottles. The classic, three-bottle drainage system requires either (external) wall suction or gravity (“water seal”) drainage (the former not being routinely recommended unless the latter is not effective). The optimal timing for tube removal is still a matter of controversy; however, the use of digital drainage systems facilitates informed and prudent decision-making in that area. A drain-clamping test before tube withdrawal is generally not advocated. Pain, drain blockage and accidental dislodgment are common complications of small-bore drains; the most dreaded complications include organ injury, hemothorax, infections, and re-expansion pulmonary edema. IPC represent a first-line palliative therapy of malignant pleural effusions in many centers. The optimal frequency of drainage, for IPC, has not been formally agreed upon or otherwise officially established.

Investigation on therapy and its opportunity for senile spontaneous pneumothorax

Objective To investigate the therapy and treatment opportunities for spontaneous pneumothorax in the older adults. Methods Clinical data and therapy outcomes of 124 elderly patients with spontaneous pneumothorax were collected in our hospital. The treatment methods and operation opportunity were summarized. Results Among 124 elderly patients, 2 cases (1.6%) were treated with oxygen and medicine conservative treatment. 42 cases (33.9%) had good degree of postoperative atelectasis after closed drainage of pleural cavity, and no obvious symptoms of pneumothorax were found by thoracic CT. 80 cases (64.5%) obtained well recovery after thoracoscope surgery, 2 cases (1.6%) had recurrence during the 6-month follow-up and recovered after conservative treatment in hospital. Conclusions The closed drainage of thoracic cavity has a good curative effect on senile spontaneous pneumothorax, but it is easy to relapse. Thoracoscope surgery has definite clinical curative effect with less recurrence. The operation opportunities should be considered accurately in order to avoid the treatment delay. Key words: Pneumothorax; Drainage; Thoracoscopes

Bronchial intractable pneumothorax balloon positioning combined with autologous blood bronchial occlusion in the therapy of intractable pneumothorax

Objective To investigate the effect and safety of bronchial balloon positioning combined with autologous blood bronchial occlusion in the treatment of intractable pneumothorax. Methods 36 cases of hospitalized patients with refractory spontaneous were collected as the research object,based on the bronchial balloon positioned upstream bronchoscopy combined with autologous blood bronchial occlusion therapy.The efficacy and adverse reactions were followed up for one year. Results In the 36 cases of spontaneous pneumothorax in patients with refractory,30 patients were successfully positioning balloon(83.33%),6 cases of patients who were not successfully positioning,were continued with conservative treatment of indwelling thoracic drainage.In 30 patients underwent successful positioning,autologous blood bronchial occlusion were used,and a total of 24 cases(80.0%) patients successfully reduced bubbles escape;6 patients relapsed,who were continued to retainthoracic drainage conservative treatment. Conclusion Bronchial balloon positioning combined with autologous blood bronchial occlusion in the treatment of intractable pneumothorax has accurate positioning and high blocking success rate,and also is safe and effective.It is worth promoting in clinical practice. Key words: Pneumothorax; Bronchoscopy

Complications in the therapy of spontaneous pneumothorax

The therapy of spontaneous pneumothorax is a common necessity in hospitals of all care hierarchies In addition to sufficient primary treatment by placement of a thorax drainage, knowledge of complicationg constellations, recognition of complications and irregular courses during the therapy of spontaneous pneumothorax are of fundamental importance for achieving a satisfactory treatment outcome. Furthermore, the enlightenment of patients regarding the pathogenesis of the disease, possible measures for influencing the recurrence rate and information about future behavioral and lifestyle modifications are important. The principal complications during hospital treatment can be subdivided into complications of the surgical placement of the thorax drain and relief of the pleural cavity, problems in the management of treatment of the pleural negative pressure, the possibly demanding management of a persisting air leak and the individualized decision-making with respect to an interventional or operative procedure. The most common complicating constellations and possible complications during the inpatient hospital stay are described, the.

Endobronchial Valves as Destination Therapy for Secondary Spontaneous Pneumothorax in a Man With Acute Myelogenous Leukemia

SESSION TITLE: Bronchology Cases II

A prospective, randomised trial of pneumothorax therapy: Manual aspiration versus conventional chest tube drainage

No consensus exists on the exact treatment of pneumothorax (PTX). Some guidelines are proposing manual aspiration (MA) to be preferred over tube thoracostomy (TT) in uncomplicated primary spontaneous pneumothorax (PSP). However, only a few studies reported a direct comparison of both methods. Our aim was to re-evaluate this with a randomised trial in a single centre in the Netherlands. Patients with a first episode of symptomatic PTX admitted to the ER or asymptomatic PTX with a size of ≥20% were recruited during 2007-2009 and followed-up for one year. Randomisation between MA and TT was balanced by a computer minimisation program for cause of PTX, smoking and gender. When first MA attempt failed, a second attempt was not undertaken and patients underwent TT. (registered at ClinicalTrials.gov (NCT00556335). 56 patients were included. Baseline characteristics were similar. Immediate success rates were 68.0% for MA versus 80.6% for TT (p=0.28). Two week success rates were 100% in both groups. There was a significant difference in hospital stay in favour of MA: 2.4±2.6 versus 4.4±3.3 days (p=0.02). One year recurrence rates in MA were lower than in TT, although not statistically significant (4.0% and 12.9% p=0.37). Predictors of immediate success were traumatic PTX and female sex. One patient died during follow-up due to heart failure. MA is simple, safe, cheap, minimal invasive in uncomplicated PSP/traumatic PTX with similar success and recurrence rates and a shorter hospital stay in comparison to TT and therefore the treatment of choice.

Pneumothorax, welche Therapie ist notwendig? Ein klinischer Überblick

Pneumothorax is defined as the accumulation of air in the pleural space. A distinction is made between a primary (idiopathic) spontaneous pneumothorax (PSP), secondary spontaneous pneumothorax (SSP) as well as between iatrogenic pneumothorax and traumatic pneumothorax. Primary spontaneous pneumothorax (PSP) occurs mainly in otherwise healthy people (mainly tall and thin young men) without any clinical sign of lung disease. In contrast, secondary pneumothorax (SSP) mostly occurs in patients with diagnosed and clinically manifested lung disease and is most frequent in older subjects (> 50 years). Smokers have a higher risk of developing pneumothorax. Most pneumothorax cases require a therapeutic intervention using thorax drainage. Observation alone is recommended for only those few patients suffering from pneumothorax without clinical symptoms. Although simple needle aspiration is often recommended as a first-line treatment, our clinical experience shows no advantage for most of the patients. All patients with symptomatic pneumothorax should be treated with immediate intercostal tube drainage. In the surgical therapy of pneumothorax, VATS (video-assisted thoracic surgery) is the current effective standard treatment. Open posterolateral thoracotomy is the recommend approach rather than the minimally invasive procedure in patient with serious illness or complications. The aim of both interventions is to reduce the recurrence rate of pneumothorax as much as possible.

Endobronchial valve therapy for pneumothorax as a bridge to lung transplantation

Endobronchial valve therapy for pneumothorax as a bridge to lung transplantation

Intraoperative Pneumothorax Identified with Transthoracic Ultrasound

Intraoperative Pneumothorax Identified with Transthoracic Ultrasound

OK432 chemical pleurodesis as a standard therapy of spontaneous pneumothorax

OK432 chemical pleurodesis as a standard therapy of spontaneous pneumothorax

Pigtail catheter for the management of pneumothorax in mechanically ventilated patients

Purpose There has been a paucity of data regarding the efficacy and safety of small-bore chest tubes (pigtail catheter) for the management of pneumothorax in mechanically ventilated patients. Methods We conducted a retrospective review of mechanically ventilated patients who underwent pigtail catheter drainage as their initial therapy for pneumothorax in the emergency department and intensive care unit from January 2004 through January 2007 in a university hospital. Results Among the 62 enrolled patients, there were 41 men (66%) and 21 women (34%), with a mean age of 63.8 ± 20.3 years. A total of 70 episodes of pneumothoraces occurred in the intensive care unit, and 48 episodes of pneumothoraces (68.6%) were successfully treated with pigtail catheters. The average duration of pigtail drainage was 5.9 days (1–27 days). No major complications occurred through use of this procedure, except for pleural infections (n = 3, 4.2%) and clogged tube (n = 1, 1.4%). Comparing the variables between the success and failure of pigtail treatment, the failure group had a significantly higher proportion of Fio 2 >60% requirement (45.5% vs. 14.6%, P = .005) and higher positive end-expiratory pressure levels (8.7 ± 3.0 vs. 6.2± 2.3 mm Hg, P = .001) at the time of pneumothorax onset than the success group. Further comparing the efficacy of pigtail drainage between barotraumas and iatrogenic pneumothorax, pigtail catheters for management of iatrogenic pneumothorax had a significantly higher success rate than barotraumas (87.5% vs. 43.3%, P < .0001). Conclusion Pigtail catheter drainage is relatively effective in treating iatrogenic but less promising for barotraumatic pneumothoraces.

Pyothorax-Associated Lymphoma: Imaging Findings

The purpose of this study was to evaluate the radiologic features of pyothorax-associated lymphoma on CT scans and chest radiographs. Radiographs and CT scans of 21 patients with biopsy-proven pyothorax-associated lymphoma (17 men, four women; median age, 71 years; range 52-77 years) were retrospectively identified. Two readers in consensus analyzed the morphologic imaging features of pyothorax-associated lymphoma and determined their relation to the preexisting chronic empyema cavity. In 13 cases, gallium scans were available and were reviewed. Sixteen patients had a history of artificial pneumothorax therapy for tuberculosis. Pyothorax-associated lymphoma was visualized mainly (71.4% of cases) as extrapulmonary pleural masses on chest radiographs. The CT features included a lenticular (60%) or crescentic (20%) soft-tissue mass located eccentrically at the margin of a coexistent empyema cavity, which was present in all cases. Masses of pyothorax-associated lymphoma were commonly located in the lateral costal pleura (50%) or at the costophrenic angle (30%). The tumor matrix often appeared heterogeneous and contained areas of necrosis (60%). Direct invasion of the chest wall, ribs, lung parenchyma, and abdomen was found in 75%, 50%, 25%, and 25% of patients. Gallium scans, when available, showed marked uptake in 10 of 13 patients (76.9%). In patients who have undergone artificial pneumothorax therapy for tuberculosis more than 20 years in the past, a pleural soft-tissue mass adjacent to the margin of a coexistent empyema cavity suggests the presence of pyothorax-associated lymphoma. Knowledge of the typical radiologic findings and locations of pyothorax-associated lymphoma help in the diagnosis of this rare pathologic entity.

Long-term effect of a thoracoscopic stapled bullectomy alone for preventing the recurrence of primary spontaneous pneumothorax

The purpose of this retrospective study was to determine the long-term efficacy of a stapled bullectomy without any symphysial procedures under videoassisted thoracoscopic surgery (VATS). A total of 121 sides of 112 patients who underwent a stapled bullectomy alone for primary spontaneous pneumothorax were retrospectively reviewed. There were 48 sides of 45 patients who underwent VATS (VATS group) and 73 sides of 67 patients who underwent open surgery (thoracotomy group). There were 12 recurrences that occurred during the follow-up periods in the VATS group (24.5%), and 3 in the thoracotomy group (4.1%). The cumulative recurrence rates in the VATS group at 2 and 10 years after a bullectomy were 16.3% and 27.5%, whereas in the thoracotomy group the recurrence rates were 2.9% and 4.9%, respectively (P < 0.001). The long-term outcome of a VATS stapled bullectomy was unsatisfactory as a radical therapy for primary spontaneous pneumothorax. A symphysial procedure should therefore be added to VATS stapled bullectomy in order to prevent long-term postoperative recurrence.

Primary chest wall lymphoma with no history of tuberculous pyothorax: Diagnosis and treatment

Primary chest wall neoplasm represents only 5% of chest wall neoplasm and among them primary chest wall lymphoma is uncommon. A 28-year-old man had no history of tuberculous pyothorax or artificial pneumothorax therapy but did have a 4-month history of dyspnea, fever, chills, and night sweats. On physical examination, a mass about 10 x 10 cm was noted on the anterior chest wall on the right side, and computed tomographic scan demonstrated that it originated from the pleural wall. A 42-year-old man was admitted with intermittent left hemithoracic pain from about 6 months before his visit. A 5 x 5-cm tender mass in the posterior wall of the left hemithorax was palpated. Computed tomography showed mild plural effusion and erosion in the posterior segment of the left ninth rib. Surgery was performed for histologic diagnosis. With the diagnosis of large B cell lymphoma, chemotherapy was prescribed for the first patient, and the patient has been in complete remission for more than 5 months. For the second patient, the left ninth rib along with the originated mass was completely resected and chemotherapy was prescribed. The patient has been in complete remission for more than 8 months. Treatment of primary chest wall lymphoma was not clear and various treatment strategies were considered. Remission of considerable duration in our patients leads us to suggest that surgery followed by adjuvant chemotherapy can provide a reasonable outcome in patients in whom the chest wall lymphoma is the only site of disease.

Pneumothorax as a Complication of Percutaneous Radiofrequency Ablation for Lung Neoplasms

The present study was performed to determine the frequency of the complication of pneumothorax after radiofrequency (RF) ablation for lung neoplasms and risk factors affecting such pneumothoraces. The study was based on 129 consecutive sessions of percutaneous RF ablation of lung neoplasms under real-time computed tomographic fluoroscopic guidance performed in a single institution between May 2003 and November 2005 in 41 patients (17 women, 24 men; mean age, 63 years; age range, 29-82 y). Correlation was determined between the incidence of pneumothorax after RF ablation and multiple factors: sex, age, presence of emphysema, lesion size, lesion depth, contact of tumor with pleura, number of punctures, maximum power of RF generator, period of ablation, tissue temperature at the end of the RF ablation session, and patient position during the procedure. Management of each case of iatrogenic pneumothorax was reviewed. Pneumothorax after RF ablation occurred in 38 of 129 RF ablation sessions (29.5%). Fourteen of the 38 cases were treated by manual aspiration, and 24 were simply observed. In five cases (3.9%), chest tube placement was required as therapy for pneumothorax. The risk of pneumothorax was significantly increased in patients with pulmonary emphysema. The frequency of pneumothorax after RF ablation in our experience is similar to the frequency of pneumothorax after lung biopsy reported in the literature. Various conditions for RF ablation did not influence the incidence of pneumothorax. Emphysema was the only individual factor that correlated significantly with the development of iatrogenic pneumothorax.