Sequential treatment of a simple pneumothorax

Vallee, Phyllis; Sullivan, Marion; Richardson, Harrison; Bivins, Brack A.; Tomlanovich, Michael C.

doi:10.1016/s0196-0644(88)80676-0

Cited by 46 publications

(24 citation statements)

References 15 publications

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“…Subsequent studies included first episodes and recurrences of PSP, as well as secondary, traumatic and iatrogenic PTX [16][17][18][19][20][21]. Except for one study [16], the catheters were catheter-over-needle systems, with no shielding of the needle tip, and were placed either with [13][14][15]23] or without [16][17][18][19][20][21][22]24] radiological or ultrasound guidance. Not surprisingly, suction applied to these small catheters functioned as well as simple MA.…”

Section: Discussionmentioning

confidence: 99%

“…When suction failed to give immediate re-expansion, connection to a one-way valve was advised, eventually followed by wall suction if the air leak continued. The failure rate of catheter wall suction when MA had failed ranged from 8-31% [16,[18][19][20][21]. Most of these studies were retrospective and therefore did not follow clear recommendations regarding the stepwise management of underlying air leaks.…”

Section: Discussionmentioning

confidence: 99%

“…Most of these studies were retrospective and therefore did not follow clear recommendations regarding the stepwise management of underlying air leaks. In contrast, VALLEE et al [16] followed a standardised approach with a small-calibre catheter in a prospective series of 37 PTX in 35 patients. Half of the cases were spontaneous PTX, but no distinction was made between primary and secondary PTX.…”

Section: Discussionmentioning

confidence: 99%

“…Such small catheters have proved successful in mixed pneumothorax (PTX) populations, most of them being iatrogenic [13][14][15][16][17][18][19][20][21][22][23][24]. The purpose of the present study was to assess the feasibility, safety and effectiveness of a comprehensive therapeutic algorithm that used small-calibre catheters connected to a one-way valve in first episodes of PSP.…”

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confidence: 99%

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Simplified stepwise management of primary spontaneous pneumothorax: a pilot study

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2006

European Respiratory Journal

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In primary spontaneous pneumothorax (PSP) requiring intervention, removal of air from the pleural space can be achieved by manual needle aspiration or by pleural drainage after insertion of a chest tube. This study aimed to evaluate the efficacy and safety of a serial-steps approach with a single system (small-calibre catheter/Heimlich valve) in a homogeneous population of patients with a first episode of PSP.All patients had an 8.5 F distally multiperforated polyurethane pigtail catheter inserted via the anterior route, at the bedside without any guidance, using the Seldinger technique. A one-way Heimlich valve was connected to the catheter, allowing the air to flow spontaneously outwards for 24-48 h. Thereafter, if the lung failed to re-expand wall suction was applied. Patients with an air leak persisting for .4 days were referred for surgery. Primary end-points were success rates at 24 h and 1 week, and 1 yr recurrence-free survival.In total, 41 consecutive patients entered the study. They were typically thin, young, smoking males. No procedure-related complications were observed. The need for pain relief medication was minimal. Within the first 24 h, most of the patients were able to walk around and half of them were able to take a shower with their catheter in place. The 24-h and 1-week success rates were 61 and 85%, respectively, and the actuarial 1-yr recurrence rate was 24%. Four patients underwent surgical pleurodesis because of a persistent air leak. The length of stay when excluding the four surgical cases was 2.3¡1.3 days.When 24-h and 1-week success rates and recurrence at 12 months were taken as end-points, the method described here is as effective as simple manual needle aspiration or a conventional chest tube thoracotomy. These results support further studies assessing this ''one system, serialsteps approach'' in an outpatient management algorithm.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Simplified stepwise management of primary spontaneous pneumothorax: a pilot study

Ch¹

2006

European Respiratory Journal

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“…These techniques have minimal morbidity, allow early discharge of a significant minority of patients and may enable the continuation of therapy through a sequential approach, albeit at a slightly higher financial cost than ''simple'' aspiration. Negative pressure suction may be added to the system in those who do not achieve full re-expansion of the lungs after 24 h, as demonstrated by VALLEE et al [19] as early as 1988. In their pilot study, MARQUETTE et al [9] demonstrate a single aspiration system that facilitates a simplified sequential steps approach to the treatment of these patients using an 8.5F catheter attached to a Heimlich one-way valve rather than an underwater seal system.…”

mentioning

confidence: 99%