Catheter drainage of spontaneous pneumothorax: suction or no suction, early or late removal?

Abstract

Twenty-three patients with primary spontaneous pneumothorax and 30 patients with secondary spontaneous pneumothorax treated by intercostal catheter drainage with underwater seal were divided randomly into two groups, one receiving suction drainage (up to 20 cm H20 pressure) and the other no suction. The success rate was 570% for the former and 50 / for the latter. The suction group spent an average of five days in hospital, whereas the non-suction group averaged four days. Suction drainage therefore did not have any advantage. To determine how soon the catheter could be removed without complication, patients were also divided randomly into two subgroupsone had the catheter removed, without previous clamping, as soon as the lung was expanded; the other had the catheters left in situ for a further three days. The success rate was 52 % for the former, and 53 % for the latter. But most of the failure in the early removal group was caused by re-collapse of the lung rather than persistent air leakage; hence removal of the catheter too early was not recommended.Spontaneous pneumothorax is usually treated by insertion of an intercostal catheter connected to underwater seal drainage. However there is no agreement on the routine use of suction drainage. Several textbooks on respiratory medicine in fact gave conflicting views. Croften and Douglas' were against suction; Holman2 seemed to recommend it whereas Hinshaw and Murray3 and Fishman4 did not specify it clearly. Moreover we know of no study to determine the best time to remove the intercostal catheter. When the lung has expanded and there is no more air leak, most would clamp the catheter for 24-48 hours. If there is no re-collapse of the lung, the catheter can be taken out. If we assume that the air leak has sealed off once the lung has fully expanded, the catheter could in theory be taken out at once without complication; hospital stay can then be shortened. We therefore undertook a prospective study to assess the efficacy of suction drainage and the optimal timing of catheter removal. MethodsBetween mid-1979 and mid-1980, 53 consecutive patients with spontaneous pneumothorax treated by intercostal catheter drainage at

Management of Spontaneous Pneumothorax and Post-Interventional Pneumothorax: German S3 Guideline

“…In a randomized study including 30 patients with SSP, the drainage duration with (up to 20 cm H 2 O) versus without suction was, however, equal [125]. The study also showed that removal of the drain is better with an interval of 2 days rather than immediately after complete re-expansion of the lung (p < 0.1).…”

“…Indication for using a suction system is also a persistent air leak (more than 48 h with indwelling drainage) with or without incomplete re-expansion of the lung. There is no evidence for the routine use of suction [125][126][127].…”

“…Literature: Guideline adaptation BTS 2010: So and Yu [125], Sharma et al [126], Reed et al [127] Consensus rate: 93%…”

Management of spontaneous pneumothorax---a Welsh survey

“…Applying suction initially did not result in an increased success rate in a study by So and Yu,11 although suction may be tried if there is a PAL. In a randomised trial of 80 trauma patients, the chest tube time was shorter with suction compared with a simple under water seal (72.2 v 92.2 hours, p=0.013) 12.…”

Clinical profile and treatment outcome of patients with spontaneous pneumothorax

“…The So Sy and Yu DYC found ICTD without suction as the better way of the treatment. 22 Suction was not used in our study. Boghaut AB and Patel RB treated 72.5% of the patients with ICTD and 5% with rest.…”