SESSION TYPE: Pleural Disease
PRESENTED ON: Sunday, October 21, 2012 at 01:15 PM - 02:45 PM
PURPOSE: No consensus exists on the exact treatment of pneumothorax (PTX). Some guidelines are proposing manual aspiration (MA) to be preferred over tube thoracostomy (TT) in uncomplicated primary spontaneous pneumothorax (PSP). However, only a few studies reported a direct comparison of both methods. Our aim was to re-evaluate this with a randomized trial in a single centre in the Netherlands.
METHODS: Patients with a first episode of symptomatic PTX admitted to the ER or asymptomatic PTX with a size of ≥20% were recruited during 2007-2009 and followed-up for one year. Randomisation between MA and TT was balanced by a computer minimisation program for cause of PTX, smoking and gender. When first MA attempt failed, a second attempt was not undertaken and patients underwent TT. (registered at ClinicalTrial.gov (NCT000556335).
RESULTS: 56 patients were included. Baseline characteristics were similar. Immediate success rates were 68.0% for MA versus 80.6% for TT (p=0.28). Two week success rates were 100% in both groups. There was a significant difference in hospital stay in favour of MA: 2.4±2.6 versus 4.4±3.3 days (p=0.02). One year recurrence rates in MA were lower than in TT, although not statistically significant (4.0% and 12.9% p=0.37). Predictors of immediate success were traumatic PTX and female sex. One patient died during follow-up due to heart failure.
CONCLUSIONS: MA is simple, safe, cheap, minimal invasive in uncomplicated PSP/ traumatic PTX with similar success and recurrence rates and a shorter hospital stay in comparison to TT and therefore the treatment of choice.
CLINICAL IMPLICATIONS: Before insertion of a chest tube, manual aspiration should be tried in patients with a first episode of pneumothorax
DISCLOSURE: The following authors have nothing to disclose: Mehmet Parlak, Steven Uil, Jan van den Berg
No Product/Research Disclosure InformationIsala Klinieken, Zwolle, Netherlands