Utilidad de la tomografía computarizada para determinar el riesgo de recidiva tras un primer episodio de neumotórax espontáneo primario. Implicaciones terapéuticas

Martínez-Ramos, David; Ángel-Yepes, Vicente; Escrig-Sos, Javier; Miralles-Tena, Juan Manuel; Salvador-Sanchís, José Luis

doi:10.1157/13106560

Cited by 22 publications

(4 citation statements)

References 21 publications

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“…These changes are often bilateral. The literature is mixed as to whether the presence or extent of ELC is directly related to the risk of recurrence, with some case series suggesting no association [9,10] and others going as far as to suggest that the presence of contralateral blebs/bullae is a risk factor for future pneumothorax and thus should be an indication for bilateral recurrence prevention [11,12]. Given that contralateral pneumothoraces are generally more of a symptomatic nuisance than a life-threatening event, this may seem an extreme point of view except in high-risk professions such as pilots or divers.…”

Section: Aetiology Of Spontaneous Pneumothoraxmentioning

confidence: 99%

Primary Spontaneous Pneumothorax: A Diffuse Disease of the Pleura

2012

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Primary spontaneous pneumothorax (PSP) is by definition not associated with any underlying lung disease. However, this does not mean that there is no underlying pathological process. It has become increasingly apparent over recent years that PSP is associated with diffuse and often bilateral abnormalities within the pleura and is not simply a disease caused by ruptured blebs/bullae. The pathological process includes emphysema-like changes, pleural porosity and inflammation. In this review, we summarise the recent advances in our understanding of the pathogenesis of PSP and discuss how this relates to management strategies for patients with PSP.

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Section: Aetiology Of Spontaneous Pneumothoraxmentioning

confidence: 99%

Primary Spontaneous Pneumothorax: A Diffuse Disease of the Pleura

2012

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“…Predicting recurrence. 14 studies were included: one RCT [33], two prospective cohort studies [64,65] and 11 retrospective single-centre case series [18,[66][67][68][69][70][71][72][73][74][75][76].…”

Section: Summary Of Evidencementioning

confidence: 99%

Joint ERS/EACTS/ESTS clinical practice guidelines on adults with spontaneous pneumothorax

Walker,

Hallifax,

Ricciardi

et al. 2024

Eur Respir J

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BackgroundThe optimal management for spontaneous pneumothorax (SP) remains contentious, with various proposed approaches. This joint clinical practice guideline from the ERS, EACTS and ESTS societies provides evidence-based recommendations for the management of SP.MethodsThis multidisciplinary Task Force addressed 12 key clinical questions on the management of pneumothorax, using ERS methodology for guideline development. Systematic searches were performed in MEDLINE and Embase. Evidence was synthesised by conducting meta-analyses, if possible, or narratively. Certainty of evidence was rated with GRADE (Grading of Recommendations, Assessment, Development and Evaluations). The Evidence to Decision framework was used to decide on the direction and strength of the recommendations.ResultsThe panel makes a conditional recommendation for conservative care of minimally symptomatic patients with primary spontaneous pneumothorax (PSP) who are clinically stable. We make a strong recommendation for needle aspiration over chest tube drain for initial PSP treatment. We make a conditional recommendation for ambulatory management for initial PSP treatment. We make a conditional recommendation for early surgical intervention for the initial treatment of PSP in patients who prioritise recurrence prevention. The panel makes a conditional recommendation for autologous blood patch in secondary SP patients with persistent air leak (PAL). The panel could not make recommendations for other interventions, including bronchial valves, suction, pleurodesis in addition to surgical resection or type of surgical pleurodesis.ConclusionsWith this international guideline, the ERS, EACTS and ESTS societies provide clinical practice recommendations for SP management. We highlight evidence gaps for the management of PAL and recurrence prevention, with research recommendations made.

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“…Some studies have noted that the risk of recurrence is much higher in patients with bullae and blebs visible at CT than in those without ( 4 ), while other studies have not found this match. Additionally, according to some authors, finding bullae and blebs at CT scan is not an indication for surgery ( 5 ). In the pediatric population, the high dose of radiation to which patients are subjected during CT should be taken into consideration.…”

Section: Introductionmentioning

confidence: 99%

Management of Primary Spontaneous Pneumothorax in a Third-Level Pediatric Surgical Center: A Retrospective Study

et al. 2022

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IntroductionThe management of primary spontaneous pneumothorax (PSP) in pediatrics remains controversial. The aim of this study was to investigate the risk of recurrence after non-surgical treatment vs. surgery, the difference in the length of stay (LOS) between various treatment options, and the role of computed tomography (CT) in the management of PSP.Materials and MethodsWe retrospectively reviewed patients admitted to our Pediatric Surgery Unit for an episode of PSP between June 2009 and July 2020. Medical records including clinical presentation at admission, diagnostics, treatments, complications, and LOS were collected.ResultsTwenty-three patients (22 males and 1 female) were included in this study. Median age was 15.65 (range 9–18). Chest X-rays were performed in all patients and showed 5 small (22%) and 18 large (78%) PSP. Chest drain was used for large PSP (≥2 cm) if the patient was clinically unstable. Eleven patients (48%) were managed non-operatively with observation alone and a recurrence rate of 18%, chest drain was used in 11 patients with a recurrence rate of 36%, and surgery was deemed necessary as a first treatment choice in one case. Six patients (27%) had an episode of relapse after non-operative management or chest drain placement. Following surgery, a relapse occurred in 2 of the 6 patients. Chest drain insertion was associated with a longer LOS than observation alone (6.36 vs. 2.4 days), and surgery resulted in a longer LOS than other types of treatment (P = 0.001).ConclusionAccording to our experience, small PSP or clinically stable larger PSP can be treated conservatively with observation alone. Operative management should be taken into consideration in children with large symptomatic PSP, persistent air leak, and/or relapse after chest drain insertion.

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Utilidad de la tomografía computarizada para determinar el riesgo de recidiva tras un primer episodio de neumotórax espontáneo primario. Implicaciones terapéuticas

Cited by 22 publications

References 21 publications

Primary Spontaneous Pneumothorax: A Diffuse Disease of the Pleura

Primary Spontaneous Pneumothorax: A Diffuse Disease of the Pleura

Joint ERS/EACTS/ESTS clinical practice guidelines on adults with spontaneous pneumothorax

Management of Primary Spontaneous Pneumothorax in a Third-Level Pediatric Surgical Center: A Retrospective Study

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