Disorders of the Pleura |

Is There a Role of Needle Aspiration in Secondary Spontaneous Pneumothorax Requiring Intervention? FREE TO VIEW

Muhammad Ganaie, MD; Shiva Bikmalla, MD; Masood Khalil, MD; Muhammad Afridi, MD; Mohammed Haris, MD; Imran Hussain, PhD
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University Hospitals of North Staffordshire, Stoke on Trent, United Kingdom

Chest. 2014;145(3_MeetingAbstracts):282A. doi:10.1378/chest.1826170
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SESSION TITLE: Pleural Disease/Pneumothorax Posters

SESSION TYPE: Poster Presentations

PRESENTED ON: Saturday, March 22, 2014 at 01:15 PM - 02:15 PM

PURPOSE: Management of secondary spontaneous pneumothorax (SSP) is more complex than the primary spontaneous pneumothorax (PSP), often requiring multiple interventions. There is paucity of data comparing the efficacy of various treatment strategies in SSP. Current British Thoracic Society guidelines recommend considering needle aspiration (NA) in symptomatic patients with small SSP. We looked at the efficacy of NA versus Intercostal Tube (ICT) drainage as the first intervention; outcomes included immediate successful re-inflation, length of stay (LOS) and recurrence at 1 year.

METHODS: We conducted a retrospective observational study of 212 consecutive pneumothorax episodes between January 2012 and December 2012 at a large tertiary centre. Those with PSP, iatrogenic pneumothorax and history of trauma were excluded. Patient case notes and plain chest radiographs were reviewed and data was analysed. P value of <0.05 was considered significant.

RESULTS: Of the 212 episodes, 30 (19%) had SSP; 5 were treated with NA and 21 with ICT as the first intervention. There was no statistically significant difference between the groups in terms of age, sex, smoking status, pneumothorax size and symptom duration. There was a trend towards lower immediate success rate (20% versus 61%; p=0.15) and higher LOS (14 days versus 7 days; p=0.80) in the NA group compared to those who had ICT. There was no difference in the rate of recurrence (20% versus 24%; p>0.99).

CONCLUSIONS: Our results show no particular advantage in using NA as first intervention over ICT. We suggest that NA should not be included in the SSP treatment algorithm in view of poor successful lung re-inflation rate and longer hospital stay; all of these eventually requiring ICT.

CLINICAL IMPLICATIONS: RCT evidence in this field is limited and the total sample size is too small to make any firm conclusions. Further large scale studies are needed to compare the effectiveness of different approaches in the management of SSP.

DISCLOSURE: The following authors have nothing to disclose: Muhammad Ganaie, Shiva Bikmalla, Masood Khalil, Muhammad Afridi, Mohammed Haris, Imran Hussain

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