Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
권호 표지
DOI QR코드

DOI QR Code

A Prospective Randomized Trial Comparing Manual Needle Aspiration to Closed Thoracostomy as an Initial Treatment for the First Episode of Primary Spontaneous Pneumothorax

  • Kim, In Ha (Department of Thoracic and Cardiovascular Surgery, Haeundae Paik Hospital, Inje University College of Medicine) ;
  • Kang, Do Kyun (Department of Thoracic and Cardiovascular Surgery, Haeundae Paik Hospital, Inje University College of Medicine) ;
  • Min, Ho-Ki (Department of Thoracic and Cardiovascular Surgery, Haeundae Paik Hospital, Inje University College of Medicine) ;
  • Hwang, Youn-Ho (Department of Thoracic and Cardiovascular Surgery, Haeundae Paik Hospital, Inje University College of Medicine)
  • Received : 2018.10.15
  • Accepted : 2018.11.12
  • Published : 2019.04.05
Download PDF
⟨ Previous Next ⟩

Abstract

Background: Variation exists in the initial treatment for the first episode of primary spontaneous pneumothorax (PSP), and no definitive consensus exists due to a lack of high-quality evidence. This study examined the outcomes of needle aspiration and closed thoracostomy in first episodes of PSP requiring intervention. Methods: This study was a randomized, prospective, single-center trial conducted between December 2015 and August 2016. Patients of all ages with a documented first episode of PSP who were unilaterally affected, hemodynamically stable, and had a pneumothorax measuring over 25% in size were included. Patients with underlying lung disease, severe comorbidities, bilateral pneumothorax, tension pneumothorax, recurrent pneumothorax, traumatic pneumothorax, and pregnancy were excluded. Patients were randomly assigned to the needle aspiration or closed thoracostomy group using a random number table. Results: Forty patients with a first episode of PSP were recruited, and 21 and 19 patients were included in the needle aspiration group and the closed thoracostomy group, respectively. The hospital stay of each group was $2.1{\pm}1.8days$ and $5.4{\pm}3.6days$, respectively (p<0.01). However, no significant differences were found in the success rate of initial treatment or the 1-month and 1-year recurrence rates. Conclusion: Needle aspiration is a favorable initial treatment in patients experiencing a first episode of PSP.

Keywords

References

  1. Light RW. Pneumothorax. In: Light RW, editor. Pleural diseases. 3rd ed. Baltimore (MD): Williams and Wilkins; 1995. p. 242-77.
  2. Choi WI. Pneumothorax. Tuberc Respir Dis (Seoul) 2014;76:99-104. https://doi.org/10.4046/trd.2014.76.3.99
  3. Bense L, Eklund G, Wiman LG. Smoking and the increased risk of contracting spontaneous pneumothorax. Chest 1987;92:1009-12. https://doi.org/10.1378/chest.92.6.1009
  4. Bense L, Eklund G, Wiman LG. Bilateral bronchial anomaly: a pathogenetic factor in spontaneous pneumothorax. Am Rev Respir Dis 1992;146:513-6. https://doi.org/10.1164/ajrccm/146.2.513
  5. Ohata M, Suzuki H. Pathogenesis of spontaneous pneumothorax: with special reference to the ultrastructure of emphysematous bullae. Chest 1980;77:771-6. https://doi.org/10.1378/chest.77.6.771
  6. Noppen M, Alexander P, Driesen P, Slabbynck H, Verstraeten A. Manual aspiration versus chest tube drainage in first episodes of primary spontaneous pneumothorax: a multicenter, prospective, randomized pilot study. Am J Respir Crit Care Med 2002;165:1240-4. https://doi.org/10.1164/rccm.200111-078OC
  7. Baumann MH, Strange C, Heffner JE, et al. Management of spontaneous pneumothorax: an American College of Chest Physicians Delphi consensus statement. Chest 2001;119:590-602. https://doi.org/10.1378/chest.119.2.590
  8. Subotic D, Van Schil P. Spontaneous pneumothorax: remaining controversies. Minerva Chir 2011;66:347-60.
  9. Wang C, Lyu M, Zhou J, Liu Y, Ji Y. Chest tube drainage versus needle aspiration for primary spontaneous pneumothorax: which is better? J Thorac Dis 2017;9:4027-38. https://doi.org/10.21037/jtd.2017.08.140
  10. Bintcliffe OJ, Hallifax RJ, Edey A, et al. Spontaneous pneumothorax: time to rethink management? Lancet Respir Med 2015;3:578-88. https://doi.org/10.1016/S2213-2600(15)00220-9
  11. Collins CD, Lopez A, Mathie A, Wood V, Jackson JE, Roddie ME. Quantification of pneumothorax size on chest radiographs using interpleural distances: regression analysis based on volume measurements from helical CT. AJR Am J Roentgenol 1995;165:1127-30. https://doi.org/10.2214/ajr.165.5.7572489
  12. Schramel FM, Sutedja TG, Braber JC, van Mourik JC, Postmus PE. Cost-effectiveness of video-assisted thoracoscopic surgery versus conservative treatment for first time or recurrent spontaneous pneumothorax. Eur Respir J 1996;9:1821-5. https://doi.org/10.1183/09031936.96.09091821
  13. MacDuff A, Arnold A, Harvey J; BTS Pleural Disease Guideline Group. Management of spontaneous pneumothorax: British Thoracic Society Pleural Disease Guideline 2010. Thorax 2010;65 Suppl 2:ii18-31.
  14. Chan SS, Lam PK. Simple aspiration as initial treatment for primary spontaneous pneumothorax: results of 91 consecutive cases. J Emerg Med 2005;28:133-8. https://doi.org/10.1016/j.jemermed.2004.11.001
  15. Parlak M, Uil SM, van den Berg JW. A prospective, randomised trial of pneumothorax therapy: manual aspiration versus conventional chest tube drainage. Respir Med 2012;106:1600-5. https://doi.org/10.1016/j.rmed.2012.08.005
  16. Harvey J, Prescott RJ. Simple aspiration versus intercostal tube drainage for spontaneous pneumothorax in patients with normal lungs. British Thoracic Society Research Committee. BMJ 1994;309:1338-9. https://doi.org/10.1136/bmj.309.6965.1338
  17. Ayed AK, Chandrasekaran C, Sukumar M. Aspiration versus tube drainage in primary spontaneous pneumothorax: a randomised study. Eur Respir J 2006;27:477-82. https://doi.org/10.1183/09031936.06.00091505
  18. Thelle A, Gjerdevik M, SueChu M, Hagen OM, Bakke P. Randomised comparison of needle aspiration and chest tube drainage in spontaneous pneumothorax. Eur Respir J 2017;49:1601296. https://doi.org/10.1183/13993003.01296-2016

Cited by

  1. An evidence‐based review of primary spontaneous pneumothorax in the adolescent population vol.2, pp.3, 2021, https://doi.org/10.1002/emp2.12449
  2. Serratus Anterior Plane Block and Intercostal Nerve Block after Thoracoscopic Surgery vol.69, pp.6, 2019, https://doi.org/10.1055/s-0040-1705152