Needle aspiration for treating iatrogenic pneumothorax after cardiac electronic device implantation: a pilot study

Domokos, Dominika; Szabó, András; Banhegyi, Gyongyver; Polgár, Balázs; Bári, Zsolt; Bogyi, Peter; Marczell, Istvan; Papp, Leticia; Kiss, Róbert Gábor; Duray, Gabor Z.; Merkely, Béla; Hizoh, István

doi:10.1007/s10840-019-00596-x

Cited by 7 publications

(9 citation statements)

References 20 publications

(36 reference statements)

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“…The median event-free period in this study was 2 (IQR 1–4) days in the vacuum bottle plus non-tunneled catheter drainage only group. This finding is compatible with previous studies, wherein the median hospital duration ranged from 1 to 5 days (Additional file 2 : Table S1) [ 10 – 12 , 17 , 22 ]. The event-free duration was almost equal to that in the subgroup of patients in the oxygen only group with size of pneumothorax less than 10% and shorter than that in patients with larger size of pneumothorax in this cohort.…”

Section: Discussionsupporting

confidence: 92%

“…The British Thoracic Society guidelines in 2010 suggested that observation alone is adequate for majority of the cases of iatrogenic pneumothorax and that, if intervention is required, simple aspiration be considered [ 9 ]. Several studies have reported that catheter aspiration for iatrogenic pneumothorax is cost effective and with few complications [ 10 – 12 ].…”

Section: Introductionmentioning

confidence: 99%

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Safety and efficacy of vacuum bottle plus catheter for drainage of iatrogenic pneumothorax

Chen

Kuo

et al. 2022

BMC Pulm Med

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Background Iatrogenic pneumothorax is common after thoracic procedures. For patients with pneumothorax larger than 15%, simple aspiration is suggested. Although vacuum bottle plus non-tunneled catheter drainage has been performed in many institutions, its safety and efficacy remain to be assessed. Methods Through this prospective cohort study (NCT03724721), we evaluated the safety and efficacy of vacuum bottle plus non-tunneled catheter drainage. Patients older than 20 years old who developed post-procedural pneumothorax were enrolled. A non-tunneled catheter was placed at the intersection of the midclavicular line and the second intercostal space. A 3-way stopcock, a drainage set, and a digital pressure gauge were connected. The stopcock was manipulated to connect the pleural space to the pressure gauge for measurement of end-expiration intrapleural pressure or to the vacuum bottle for air drainage. The rate of successful drainage, the end-expiration intrapleural pressure before, during, and after the procedure and the duration of hospitalization were recorded. Results From August 2018 to February 2020, 21 patients underwent vacuum bottle plus catheter drainage (intervention group) and 31 patients received conservative treatment (control group). The end-expiration intrapleural pressure of all patients remained less than − 20 cmH2O during drainage. No procedure related complication was observed. Large pneumothorax (≥ 15%) was associated with higher risk of persistent air leak (Odds ratio 12, 95% CI 1.2–569.7). Vacuum bottle assisted air drainage yielded shorter event-free duration than that of conservative treatment (2 days vs 5 days [interquartile range 1–4 days vs 3–7 days], p < .05). Vacuum bottle assisted air drainage also help identifying patients with persistent pneumothorax and necessitate the subsequent management. The event-free duration of persistent air leak in the intervention group was also comparable with that of conservative treatment (5 days vs 5 days [interquartile range 5–8 days vs 3–7 days], p = .45). Conclusions Vacuum bottle plus catheter drainage of iatrogenic pneumothorax is a safe and efficient procedure. It may be considered as an alternative management of stable post-procedural pneumothorax with size larger than 15%. Trial registration The study protocol was approved by the Research Ethics Committee of National Taiwan University Hospital (No. 201805105DINA) on 6th August, 2018. The first participant was enrolled on 23rd August, 2018 after Research Ethics Committee approval. This clinical trial complete registration at U.S. National Library of Medicine clinicaltrials.gov with identifier NCT03724721 and URL: https://clinicaltrials.gov/ct2/show/NCT03724721 on 30th October, 2018.

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Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Safety and efficacy of vacuum bottle plus catheter for drainage of iatrogenic pneumothorax

Chen

Kuo

et al. 2022

BMC Pulm Med

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“…The event-free duration was almost equal to that in the subgroup of patients in the oxygen only group with size of pneumothorax less than 10% and shorter than that in patients with larger size of pneumothorax in this cohort. Moreover, all patients who required subsequent pigtail placement achieved full lung expansion in this study, with an event-free period of 5 (IQR, 5-8) days, which was comparable to the event-free duration of 6 to 7 days with primary tube thoracostomy reported in previous studies 16, 20 . **The study did not separate patients with pneumothorax of different etiologies (included both spontaneous pneumothorax and traumatic pneumothorax).…”

Section: Discussionsupporting

confidence: 84%

Safety and Efficacy of Vacuum Bottle Plus Catheter for Drainage of Iatrogenic Pneumothorax

Chen

Kuo

et al. 2021

Preprint

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Iatrogenic pneumothorax is common after thoracic procedures. For pneumothorax larger than 15%, simple aspiration is suggested. This clinical trial (NCT03724721) assessed the safety and efficacy of vacuum bottle plus non-tunneled catheter air drainage, which has long been performed in many institutions. From August 2018 to February 2020, patients older than 20 years of age who developed iatrogenic pneumothorax were prospectively enrolled. Totally 21 patients underwent vacuum bottle plus catheter drainage. The median size of pneumothorax was 19.6%, as measured by Rhea’s method. Of the 21 patients, 15 had successful air drainage, and the remaining 6 patients required subsequent pigtail placement. The end-expiratory intrapleural pressure of all patients remained less than -20 cmH2O during drainage. The median duration of hospitalization was 2 (interquartile range [IQR], 1-4) days. No procedure-related complication was observed. A retrospective analysis of patients who received conservative treatment showed that the median duration of hospitalization was longer in patients with larger pneumothorax (1 day vs. 5 days [IQR, 1-1 day vs. 3-7 days]). This study showed that vacuum bottle plus catheter drainage of iatrogenic pneumothorax is a safe and efficient procedure. It is recommended as initial management of stable iatrogenic pneumothorax with size larger than 15%.

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“…A recent single-centre observational study evaluated a strategy of drainage with fine needle aspiration. 12 This approach was successful in over half of patients and resulted in decreased length of hospital stay. This approach is recommended by the British Thoracic Society for early management of a spontaneous pneumothorax or small secondary pneumothorax; however, it is not strongly endorsed by other society guidelines.…”

Section: Discussionmentioning

confidence: 99%

The Natural History and Treatment of Cardiac Implantable Electronic Device Associated Pneumothorax—A 10-Year Single-Centre Experience

et al. 2021

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Background Pneumothorax is a common complication of cardiac implantable electronic device (CIED) procedures. There is a paucity of data on the natural history and management of a CIED-associated pneumothorax. Methods This is a single-centre retrospective study of all consecutive patients with a CIED-associated pneumothorax between March 2010 and March 2020. Pneumothorax size was determined on all chest x-rays after device implantation and before chest tube insertion (if placed). Changes in pneumothorax size on serial chest x-rays were reported. Clinical outcomes in patients with a severe-sized pneumothorax treated with a chest tube were compared with those treated conservatively. Results A total of 86 CIED-associated pneumothoraxes were identified, with 55 (63.9%) patients having a pneumothorax severe in size. Thirty-seven patients with a severe pneumothorax received a chest tube, whereas 18 were managed conservatively. Chest tube use was associated with a higher rate of admission to hospital (100% vs 63%, P = 0.02) for patients undergoing outpatient procedure, longer length of stay (6.3 ± 3.9 vs 2.7 ± 2.9 days, P = 0.04), but fewer chest x-rays (1.9 ± 0.7 vs 4.1 ± 2.5, P = 0.002). Conclusion An initial strategy of conservative management of a CIED-associated pneumothorax in select patients may be feasible and safe.

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Needle aspiration for treating iatrogenic pneumothorax after cardiac electronic device implantation: a pilot study

Cited by 7 publications

References 20 publications

Safety and efficacy of vacuum bottle plus catheter for drainage of iatrogenic pneumothorax

Safety and efficacy of vacuum bottle plus catheter for drainage of iatrogenic pneumothorax

Safety and Efficacy of Vacuum Bottle Plus Catheter for Drainage of Iatrogenic Pneumothorax

The Natural History and Treatment of Cardiac Implantable Electronic Device Associated Pneumothorax—A 10-Year Single-Centre Experience

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