PURPOSE: The optimum treatment of primary spontaneous pneumothorax (PSP) has not been determined, and current guidelines give conflicting recommendations regarding the treatment of PSP. The objective of this pilot study is to assess the safety and feasibility of simple aspiration and outpatient management of PSP.
METHODS: Consecutive patients with PSP meeting inclusion/exclusion criteria were enrolled. Patients were treated with a small bore chest tube and simple aspiration. If aspiration was successful, the tube was removed and the patient discharged. If unsuccessful, the patient was discharged with the chest tube connected to a Heimlich valve. All patients were followed up at 48-72 hours, one week, and 30 days. Primary outcomes were safety and feasibility of the protocol.
RESULTS: Six males and four females were enrolled. Eight patients were current or former smokers. Five pneumothoraces occurred on the right and five on the left. Aspiration was successful in 3 patients. One patient had a recurrent pneumothorax two days after successful aspiration. Seven patients failed simple aspiration and were discharged with chest tubes attached to Heimlich valves. Of these, two patients had resolution of their pneumothoraces within 72 hours and two by one week of enrolment. One of these patients had recurrence 24 days after initial presentation. Of the 10 patients, three required surgery and two required hospitalization for suction for failed aspiration or recurrence. There were no complications related to chest tube placement or to discharge home with a chest tube and Heimlich valve.
CONCLUSION: Simple aspiration can be used as an initial treatment modality in patients with PSP. Outpatient treatment with a chest tube and Heimlich valve is safe.
CLINICAL IMPLICATIONS: Our protocol provides a safe method for further studies of the effectiveness of outpatient management of PSP. A large, multicentre randomized control trial is needed to assess the efficacy of aspiration for PSP and to determine the optimum management of patients who fail aspiration.
DISCLOSURE: Charlene Fell, None.