A Prospective Randomized Trial Comparing Manual Needle Aspiration to Closed Thoracostomy as an Initial Treatment for the First Episode of Primary Spontaneous Pneumothorax

Abstract

Background Variation exists in the initial treatment for the first episode of primary spontaneous pneumothorax (PSP), and no definitive consensus exists due to a lack of high-quality evidence. This study examined the outcomes of needle aspiration and closed thoracostomy in first episodes of PSP requiring intervention. Methods This study was a randomized, prospective, single-center trial conducted between December 2015 and August 2016. Patients of all ages with a documented first episode of PSP who were unilaterally affected, hemodynamically stable, and had a pneumothorax measuring over 25% in size were included. Patients with underlying lung disease, severe comorbidities, bilateral pneumothorax, tension pneumothorax, recurrent pneumothorax, traumatic pneumothorax, and pregnancy were excluded. Patients were randomly assigned to the needle aspiration or closed thoracostomy group using a random number table. Results Forty patients with a first episode of PSP were recruited, and 21 and 19 patients were included in the needle aspiration group and the closed thoracostomy group, respectively. The hospital stay of each group was 2.1±1.8 days and 5.4±3.6 days, respectively (p<0.01). However, no significant differences were found in the success rate of initial treatment or the 1-month and 1-year recurrence rates. Conclusion Needle aspiration is a favorable initial treatment in patients experiencing a first episode of PSP.

An evidence‐based review of primary spontaneous pneumothorax in the adolescent population

“…In adults, recent RCTs and a Cochrane review comparing both methods found no differences in recurrence rates, whereas needle aspiration resulted in shorter duration of hospitalization and fewer adverse events. [68][69][70][71] In contrast to adults, tube thoracostomy is favored over needle aspiration in pediatric patients. Retrospective and prospective studies examining needle aspiration in pediatric patients with PSP report success rates of approximately 50%, which is lower than cited rates in adults.…”

“…If an initial attempt at needle aspiration is not successful, we suggest a second attempt to be performed, as studies in adults suggest a high success rate for lung expansion with a second attempt. 69,70 We recommended small-bore chest tubes (<14 French) be inserted via the Seldinger technique 76 due to equivalent efficacy compared with larger tubes and lower adverse effects. 10,[77][78][79][80] We recommend against the immediate use of suction.…”

Serratus Anterior Plane Block and Intercostal Nerve Block after Thoracoscopic Surgery

“…Thus, many studies have been currently conducted to reduce the size of the chest tube or not to insert the chest tube postoperative period after thoracic surgery. 6,[25][26][27] Our study has several limitations. First, it was impossible to assess the sensory range and insufficient block rate precisely in both ICNB and SAPB because both methods were performed after the induction of general anesthesia.…”

Conservative Treatment Approach in Primary Spontaneous Pneumothorax

“…Needle aspiration, small or large bore catheters are used in the treatment of pneumothorax and no significant difference was found between procedure success. 17,18 In addition, Terzi et al evaluated small and large diameter thoracic catheters in terms of pain and stated that small diameter thoracic catheter caused less pain. 19 Although the authors did not evaluate patients treated with large thoracic catheters in this study, it was observed that the conservative approach and treatment with small catheters were sufficient for treatment and were more comfortable for patients.…”