Pigtail catheters vs large-bore chest tubes for management of secondary spontaneous pneumothoraces in adults

Tsai, Wen-Kai; Chen, Wei; Lee, Jen-chih; Cheng, Wen-Ling; Chen, Chia-Hung; W, Hsu; Shih, Chuen-Ming

doi:10.1016/j.ajem.2006.04.006

Cited by 68 publications

(42 citation statements)

References 20 publications

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“…and large lumen chest drains [115,116,189,190]. It was shown that small-lumen thorax drainages are less painful, lead to fewer inflammatory complications and bleeding [115,116] and to shorter indwelling times [115,116,190].…”

Section: Evidence Gradementioning

confidence: 99%

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

et al. 2018

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In Germany, 10,000 cases of spontaneous pneumothorax are treated inpatient every year. The German Society for Thoracic Surgery, in co-operation with the German Society for Pulmonology, the German Radiological Society, and the German Society of Internal Medicine has developed an S3 guideline on spontaneous pneumothorax and post-interventional pneumothorax moderated by the German Association of Scientific Medical Societies. Method: Based on the source guideline of the British Thoracic Society (2010) 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 3 consensus conferences by the nominal group process. Results: 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. 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 post-interventional spontaneous pneumothorax is similar to that of primary spontaneous pneumothorax. Discussion: 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.

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Section: Evidence Gradementioning

confidence: 99%

“…Literature: de Novo Research: Nakajima et al [16], Ichinose et al [189] Ota et al [15] Consensus rate: 100%…”

Section: Evidence Gradementioning

confidence: 99%

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

et al. 2018

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“…Awaiting recurrence prevention treatment, air evacuation can be achieved by simple manual aspiration in young (<50 years old) patients with small pneumothoraces [41], but most authors and guidelines recommend immediate insertion of a chest tube. Small bore chest tubes and even pigtail catheters [81] are usually sufficient; large-bore chest tubes are recommended when large air leaks are suspected or when mechanical positive pressure ventilation is required [42]. Recurrence prevention using a thoracoscopic approach (medical or thoracoscopic) is recommended; in case a visible air leak is present (e.g., a ruptured emphysematous bulla), air leak closure using electrocautery or stapling is indicated.…”

Section: Secondary Spontaneous Pneumothoraxmentioning

confidence: 99%

Pneumothorax

Noppen

Keukeleire²

2008

Respiration

270

232

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“…1,2 Complications of tube thoracostomy include infection, tube malpositioning, laceration, and hemothorax, all of which may worsen outcome. [3][4][5][6][7][8][9] Several studies have compared the safety and efficacy of different chest tube sizes 3,[10][11][12] and various methods of chest tube removal. 13,14 Chest tube duration would seem to be an important management issue that might impact outcome, but there is a paucity of data on the impact of and risk factors affecting prolonged chest tube duration in patients with pneumothorax.…”

Section: Introductionmentioning

confidence: 99%

Impact and Predictors of Prolonged Chest Tube Duration in Mechanically Ventilated Patients with Acquired Pneumothorax

Kao

Chen

et al. 2013

Respir Care

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BACKGROUND: Prolonged chest tube duration is less well studied in patients who are supported by mechanical ventilation and have acquired pneumothorax. We investigated the impact of prolonged chest tube duration on patient outcomes and the risk factors associated with prolonged chest tube duration. METHODS: This retrospective observational study included 106 ventilated subjects who had been treated with thoracostomy for pneumothorax between May 2004 and December 2011. We analyzed 61 subjects and 63 events. The subjects were divided into a prolonged chest tube duration group (> 18 d) and a non-prolonged group (< 18 d). RESULTS: Subjects with prolonged chest tube duration had significantly higher ICU mortality (P ‫؍‬ .006), longer ICU stay (P ‫؍‬ .001), longer hospitalization (P ‫؍‬ .004), longer mechanical ventilation after development of pneumothorax (P ‫؍‬ .003), higher maximum peak inspiratory pressure (P ‫؍‬ .03), and a higher rate of surgical emphysema (P ‫؍‬ .009). High peak inspiratory pressure and surgical emphysema remained independent predictors of prolonged chest tube duration after multivariate logistic regression analysis. The probability of chest tube removal within 28 days was significantly lower in subjects with both high peak inspiratory pressure and surgical emphysema, compared to subjects without any risk factors (log rank P ‫؍‬ .001). CONCLUSIONS: High peak inspiratory pressure and surgical emphysema are independent predictors of prolonged chest tube duration and negatively impact clinical outcomes in this patient group. These findings may provide information for better chest tube management.

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Pigtail catheters vs large-bore chest tubes for management of secondary spontaneous pneumothoraces in adults

Cited by 68 publications

References 20 publications

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

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

Pneumothorax

Impact and Predictors of Prolonged Chest Tube Duration in Mechanically Ventilated Patients with Acquired Pneumothorax

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