Spontaneous pneumothorax: marker gas technique for predicting outcome of manual aspiration.

Seaton, Douglas; Yoganathan, Kathir; Coady, T.; Barker, Richard

doi:10.1136/bmj.302.6771.262

Cited by 40 publications

(19 citation statements)

References 5 publications

(2 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Patients in whom no marker gas was detected (n = 7) did uniformly well with none requiring intercostal tube drainage whereas 2 of the 3 patients with marker gas detectable in the aspirate required intercostal tube drainage. In all patients studied, the post-aspiration radiograph showed a reduction in size of the pneumothorax but in 2 of these patients, subsequent radiographs demonstrated further lung collapse requiring insertion of an intercostal drain, confirming the findings of previous investigators who have observed that the post-aspiration radiograph is not a reliable predictor of subsequent clinical outcome [4, 8]. In 1 patient, lung expansion was sustained after a single aspiration despite the presence of marker gas in the pneumothorax aspirate.…”

Section: Discussionsupporting

confidence: 78%

“…A 16-gauge plastic cannula was inserted aseptically at an appropriate site in the chest wall and was connected to a 60-ml syringe by a three way tap, with an exit tube leading from the tap to a portable flame ioniser (Gas-Tec, Research Engineers, London, UK) capable of detecting hydrocarbon gases at concentrations of less than 1 ppm, as previously described [8]. Recordings were made of the volumes of gas aspirated, whether or not chlorofluorocarbon marker gases were present and, if so, the volume of the aspirate at which they were first detected.…”

Section: Methodsmentioning

confidence: 99%

“…Some groups [2]advocate conventional chest tube therapy as initial treatment for iatrogenic pneumothorax whereas others advocate the use of simple aspiration [4]or the use of short-term small-calibre tubes [5, 6]. Unfortunately, in up to 25% of cases, simple aspiration will fail [4, 5, 7], and these patients are difficult to identify in advance as the post-aspiration radiograph is not always a reliable indicator of whether the pleural leak remains [4, 8]. Depending on the stage of evolution of the pneumothorax there may be an on-going air leak such that the lung may be deflating at the time of aspiration, or the leak may have closed as a consequence of lung collapse.…”

Section: Introductionmentioning

confidence: 99%

“…We have previously shown that a flame ionisation technique can be used to identify the presence of hydrocarbons in pressurised metered dose inhalers [9]and we have adapted this method to reliably detect pleural leaks during manual aspiration of spontaneous pneumothoraces [8]. This study examines whether this marker gas technique can be used to identify patients with iatrogenic pneumothoraces who have pleural leaks which may require intercostal tube drainage and identify a low-risk group with no evidence of a pleural leak who can be treated by simple aspiration.…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Iatrogenic Pneumothorax: Marker Gas Technique for Predicting Outcome of Manual Aspiration

Kiely

Davey²,

Mahadevan³

et al. 2001

Respiration

View full text Add to dashboard Cite

Background: Although manual aspiration is used for treating pneumothorax, the post-aspiration radiograph may not be a reliable indicator of whether the pleural leak remains. We have previously shown that marker gas can identify an air leak in patients with spontaneous pneumothoraces. Objective: This study examines whether a marker gas technique can be safely used to manage patients with iatrogenic pneumothoraces. Methods: 10 patients with iatrogenic pneumothorax were identified among a cohort referred for manual aspiration of pneumothorax, using a marker gas technique, in which inspired metered-dose inhaler propellant gas is detectable in pneumothorax aspirate using a portable flame ioniser. The presence of marker gas was taken to imply a persistent air leak. Results: Marker gas was detected in the aspirate from 3 out of 10 pneumothoraces. 2 required intercostal tube drainage because of lung collapse following initial aspiration and 1 was treated conservatively. Marker gas was not detected in 7 cases (2 post-pacemaker insertion, 5 pleural aspiration ± biopsy), and in all these cases, manual aspiration resulted in sustained re-expansion of the lung. There was a trend towards a significant relationship between the presence or absence of marker gas and the need for a further intervention (p = 0.055). Conclusion: The presence or absence of a pleural leak during manual aspiration of iatrogenic pneumothorax can be demonstrated by this technique. The absence of marker gas in the aspirate implies that manual aspiration will be successful, whereas its presence, in most cases, predicts either failure of manual aspiration to expand the lung or early re-collapse of the lung.

show abstract

Section: Discussionsupporting

confidence: 78%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Iatrogenic Pneumothorax: Marker Gas Technique for Predicting Outcome of Manual Aspiration

Kiely

Davey²,

Mahadevan³

et al. 2001

Respiration

View full text Add to dashboard Cite

show abstract

“…The historic practice of simple aspiration, which is extremely easy to learn and carry out, which involves minimal discomfort for the patient, and which does not demand hospitalization, should always be attempted first. Since 1982, at least seven studies in 233 patients from the United States [2][3], Australia [4], United Kingdom [5][6][7] and Singapore [8] have shown that where simple aspiration is attempted, satisfactory re-expansion is achieved in 70% of patients with normal lung function; even in those Mayday University Hospital, Croydon, Surrey CR7 7YE, UK.…”

mentioning

confidence: 99%