Conservative treatment for recurrent secondary spontaneous pneumothorax in patients with a long recurrence-free interval

Kim, In Sub; Kim, Jae Jun; Han, Jung Wook; Jeong, Seong Cheol; Kim, Yong Hwan

doi:10.21037/jtd.2020.03.52

Cited by 11 publications

(9 citation statements)

References 20 publications

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“…In the only RCT comparing a conservative strategy with invasive treatment with CTD for the first episode of moderate-to-large PSP [ 12 , 121 ], no instructions for activity limitation were given. Similarly, no guideline regarding activity were provided in the assessing the conservative strategy for recurrent SSP [ 122 ]. The ACCP, BTS and ERS task force guidelines do not recommend any activity limitation with the conservative strategy [ 2 , 4 , 15 ].…”

Section: Summary Of the Resultsmentioning

confidence: 99%

SPLF/SMFU/SRLF/SFAR/SFCTCV Guidelines for the management of patients with primary spontaneous pneumothorax

Jouneau,

Ricard,

Seguin-Givelet

et al. 2023

Ann. Intensive Care

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Introduction Primary spontaneous pneumothorax (PSP) is the presence of air in the pleural space, occurring in the absence of trauma and known lung disease. Standardized expert guidelines on PSP are needed due to the variety of diagnostic methods, therapeutic strategies and medical and surgical disciplines involved in its management. Methods Literature review, analysis of the literature according to the GRADE (Grading of Recommendation, Assessment, Development and Evaluation) methodology; proposals for guidelines rated by experts, patients and organizers to reach a consensus. Only expert opinions with strong agreement were selected. Results A large PSP is defined as presence of a visible rim along the entire axillary line between the lung margin and the chest wall and ≥ 2 cm at the hilum level on frontal chest X-ray. The therapeutic strategy depends on the clinical presentation: emergency needle aspiration for tension PSP; in the absence of signs of severity: conservative management (small PSP), needle aspiration or chest tube drainage (large PSP). Outpatient treatment is possible if a dedicated outpatient care system is previously organized. Indications, surgical procedures and perioperative analgesia are detailed. Associated measures, including smoking cessation, are described. Conclusion These guidelines are a step towards PSP treatment and follow-up strategy optimization in France.

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Section: Summary Of the Resultsmentioning

confidence: 99%

SPLF/SMFU/SRLF/SFAR/SFCTCV Guidelines for the management of patients with primary spontaneous pneumothorax

Jouneau,

Ricard,

Seguin-Givelet

et al. 2023

Ann. Intensive Care

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“…In patients with a chest tube insertion, recurrence occurs as much as 26% in the first 6 33% in 1 year afterwards, and 50% in 3 years later. 16 Prognosis of pneumothorax patients with TB is commonly good, according to the treatment of TB as an underlying disease. 17 Lung rehabilitation in the patient had been performed since the beginning of the therapy.…”

Section: Discussionmentioning

confidence: 99%

Needle Aspiration in Tuberculosis-Associated Secondary Spontaneous Pneumothorax

Candrawati,

Indraswari,

Komalasari

2024

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Introduction: The management of tuberculosis-associated secondary spontaneous pneumothorax mostly requires chest tube insertion for complete drainage and resolution. We reported a case of tuberculosis-associated secondary spontaneous pneumothorax that improved with needle aspiration. Case: A 29-year-old female with pulmonary tuberculosis presented with sudden onset shortness of breath. Chest examination revealed asymmetry, decreased vocal fremitus, hypersonor, and decreased vesicular sound in the right lung field. Chest radiograph showed right pneumothorax with a 2 cm intrapleural distance. Needle aspiration was performed because the patient refused chest tube insertion. The first needle aspiration evacuated approximately 615 cc of air. The second needle aspiration was repeated 24 hours later due to clinical deterioration, and 610 cc of air was evacuated. Chest radiograph evaluation on the 6th day of treatment showed no pneumothorax. During hospitalization, the patient received oxygen therapy, anti-tuberculosis drugs, chest physiotherapy, and other symptomatic therapies such as mucolytics. The patient's condition improved, and she was discharged on the 9th day of hospitalization. Tuberculosis-associated secondary pneumothorax occurs in 1-3% of cases. Conclusion: Needle aspiration is a therapeutic modality for tuberculosis-associated secondary spontaneous pneumothorax. This modality has several advantages, including shorter length of stay, less cost and pain, and fewer complications. Needle aspiration combined with oxygen therapy, anti-tuberculosis drugs, and chest physiotherapy should be the modality of treatment for tuberculosis-associated secondary pneumothorax.

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“…Onuki et al defined recurrence as an episode occurring at least 30 days after surgery and thought that recurrent events within the first 30 days after surgery were part of the staple-healing process [ 10 ]. On the other hand, Hsu et al considered any recurrence at any time after an operation to be PoR [ 7 ], while Kim et al considered a one-year mark as the cutoff to define early recurrence [ 11 ]. However, to the best of our knowledge, no study has evaluated the relationship between different clinical prognoses and the temporal patterns of recurrence after surgery.…”

Section: Discussionmentioning

confidence: 99%

Early Postoperative Pneumothorax Might Not Be ‘True’ Recurrence

Woo

Kim

et al. 2021

JCM

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Objectives: To date, there is no consensual definition of what constitutes a postoperative recurrence of primary spontaneous pneumothorax (PSP), despite there being many studies reporting a high incidence of recurrence. This study aims to describe the long-term recurrence rates of pneumothorax and to suggest a possible way to differentiate recurrence events based on temporal patterns. Methods: This single-center study retrospectively evaluated all postoperative recurrence of PSP from January 2007 to May 2019. Patients’ demographics, history of pneumothorax, radiologic data, surgical technique, and the time between operation and recurrence were analyzed. Univariate and multivariable analyses were conducted to find potential risk factors related to long-term recurrence. Results: Of the 77 postoperative recurrent cases of pneumothorax, 21 (27.2%) occurred within 30 days after surgery and, thus, were classified as early recurrences (ER), while the remaining cases were classified as late recurrences (LR). There was no difference in preoperative variables between the two groups. However, the rate of incidence of second recurrence (SR), which represented a long-term prognosis, was significantly higher in the LR group (28.6% vs. 4.8%, p = 0.030). On univariate and multivariable analyses, late recurrence was the only significant factor predicting later recurrence events. Conclusion: Postoperative recurrence (PoR) within 30 days had a lower SR rate. Therefore, it might not be a ‘true’ postoperative recurrence with a favorable prognosis. Further studies investigating postoperative recurrence based on temporal patterns would be warranted to improve the classification of PoR.

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Conservative treatment for recurrent secondary spontaneous pneumothorax in patients with a long recurrence-free interval

Cited by 11 publications

References 20 publications

SPLF/SMFU/SRLF/SFAR/SFCTCV Guidelines for the management of patients with primary spontaneous pneumothorax

SPLF/SMFU/SRLF/SFAR/SFCTCV Guidelines for the management of patients with primary spontaneous pneumothorax

Needle Aspiration in Tuberculosis-Associated Secondary Spontaneous Pneumothorax

Early Postoperative Pneumothorax Might Not Be ‘True’ Recurrence

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