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Spontaneous pneumothorax: time to depart from the ‘chest tube underwater seal’?

Abstract

Initial management of spontaneous pneumothorax has traditionally been inserting a chest tube and attaching it to an underwater seal and hospitalizing the patient. New options have emerged that allow management to be on an outpatient basis without the need for hospitalization. These options are needle aspiration (similar to aspiration of effusion) or attaching the chest tube to a one-way valve. So, is chaining a patient with spontaneous pneumothorax to their hospital bed because of the heavy jar attached to the chest tube the most prudent way of management? This review attempts to answer this question.

References

  1. Kaya SO, Karatepe M, Tok T, Onem G, Dursunoglu N, Goksin I. Were pneumothorax and its management known in 15th-century anatolia? Tex Heart Inst J 2009;36:152–153.

    PubMed  PubMed Central  Google Scholar 

  2. Bintcliffe OJ, Hallifax RJ, Edey A, Feller-Kopman D, Lee YCG, Marquette CH, et al. Spontaneous pneumothorax:time to rethink management? Lancet Respir Med 2015;3:578–588.

    Article  Google Scholar 

  3. MacDuff A, Arnold A, Harvey J, on behalf of the BTS Pleural Disease Guideline Group. Management of spontaneous pneumothorax:British Thoracic Society pleural disease guideline 2010. Thorax 2010;65:ii18–ii31.

    Article  Google Scholar 

  4. Tschopp J-M, Bintcliffe O, Astoul P, Canalis E, Driesen P, Janssen J, et al. ERS task force statement:diagnosis and treatment of primary spontaneous pneumothorax. Eur Respir J 2015;46:321–335.

    Article  Google Scholar 

  5. Baumann MH, Strange C, Heffner JE, Light R, Kirby TJ, Klein J, et al. Management of spontaneous pneumothorax:an American College of Chest Physicians Delphi consensus statement. Chest 2001;119:590–602.

    Article  CAS  Google Scholar 

  6. Kelly A-M, Loy J, Tsang AYL, Graham CA. Estimating the rate of reexpansion of spontaneous pneumothorax by a formula derived from computed tomography volumetry studies. Emerg Med J 2006;23:780–782.

    Article  Google Scholar 

  7. Hallifax RJ, Yousuf A, Jones HE, Corcoran JP, Psallidas I, Rahman NM. Effectiveness of chemical pleurodesis in spontaneous pneumothorax recurrence prevention:a systematic review. Thorax 2016; Online First:01 November 2016. doi:10.1136/thoraxjnl-2015-207967.

  8. Hamilton AA, Archer GJ. Treatment of pneumothorax by simple aspiration. Thorax 1983;38:934–936.

    Article  CAS  Google Scholar 

  9. Klassen KP, Meckstroth CV. Treatment of spontaneous pneumothorax:prompt expansion with controlled thoracotomy tube suction. JAMA 1962;182:1–5.

    Article  CAS  Google Scholar 

  10. Ruckley CV, McCormack RJ. The management of spontaneous pneumothorax. Thorax 1966;21:139–144.

    Article  CAS  Google Scholar 

  11. Obeid FN, Shapiro MJ, Richardson HH, Horst HM, Bivins BA. Catheter aspiration for simple pneumothorax (CASP) in the outpatient management of simple traumatic pneumothorax. J Trauma 1985;25:882–886.

    Article  CAS  Google Scholar 

  12. Vallee P, Sullivan M, Richardson H, Bivins B, Tomlanovich M. Sequential treatment of a simple pneumothorax. Ann Emerg Med. 1988; 17:936–942.

    Article  CAS  Google Scholar 

  13. Bernstein A, Waqaruddin M, Shah M. Management of spontaneous pneumothorax using a Heimlich flutter valve. Thorax 1973;28:386–389.

    Article  CAS  Google Scholar 

  14. Brims FJH, Maskell NA. Ambulatory treatment in the management of pneumothorax:a systematic review of the literature. Thorax 2013;68:664–669.

    Article  Google Scholar 

  15. Ayed AK, Chandrasekaran C, Sukumar M. Aspiration versus tube drainage in primary spontaneous pneumothorax:a randomised study. Eur Respir J. 2006;27:477–482.

    Article  CAS  Google Scholar 

  16. 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;165:1240–1244.

    Article  Google Scholar 

  17. Parlak M, Uil SM, van den Berg JWK. A prospective, randomised trial of pneumothorax therapy:manual aspiration versus conventional chest tube drainage. Respir Med 2012;106:1600–1605.

    Article  Google Scholar 

  18. Wakai A, O’Sullivan RG, McCabe G. Simple aspiration versus intercostal tube drainage for primary spontaneous pneumothorax in adults. Cochrane Database Syst Rev 2007; 24:CD004479.

    Google Scholar 

  19. 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.

    Article  Google Scholar 

  20. Devanand A, Koh MS, Ong TH, Low SY, Phua GC, Tan KL, et al. Simple aspiration versus chest-tube insertion in the management of primary spontaneous pneumothorax:a systematic review. Respir Med 2004;98:579–590.

    Article  CAS  Google Scholar 

  21. Janssen J, Cardillo G. Primary spontaneous pneumothorax:towards outpatient treatment and abandoning chest tube drainage. Respiration 2011;82:201–203.

    Article  Google Scholar 

  22. Marquette C-H. Marx A, Leroy S, Vaniet F, Ramon P, Caussade S, et al. Simplified stepwise management of primary spontaneous pneumothorax:a pilot study. Eur Respir J. 2006;27:470–476.

    Article  Google Scholar 

  23. Massongo M, Leroy S, Scherpereel A, Vaniet F, Dhalluin X, Chahine B, et al. Outpatient management of primary spontaneous pneumothorax:a prospective study. Eur Respir J 2014;43:582–590.

    Article  Google Scholar 

  24. Voisin F, Sohier L, Rochas Y, Kerjouan M, Ricordel C, Belleguic C, et al. Ambulatory management of large spontaneous pneumothorax? With pigtail catheters. Ann Emerg Med 2014;64:222–228.

    Article  Google Scholar 

  25. Woo WG, Joo S, Lee GD, Haam SJ, Lee S. Outpatient treatment for pneumothorax using a portable small-bore chest tube:a clinical report. Korean J Thorac Cardiovasc Surg 2016;49:185–189.

    Article  Google Scholar 

  26. Ho KK, Ong MEH, Koh MS, Wong E, Raghuram J. A randomized controlled trial comparing minichest tube and needle aspiration in outpatient management of primary spontaneous pneumothorax. Am J Emerg Med 2011;29:1152–1157.

    Article  Google Scholar 

  27. Baumann MH, Patel PB, Roney CW, Petrini MF. Comparison of function of commercially available pleural drainage units and catheters. Chest 2003;123:1878–1886.

    Article  Google Scholar 

  28. Kelly A-M, Clooney M, Spontaneous Pneumothorax Australia Study Group. Deviation from published guidelines in the management of primary spontaneous pneumothorax in Australia. Intern Med J 2008;38:64–67.

    Article  Google Scholar 

  29. Korraa E, Madkour A, Shoukri A, Ahmed S. Outcome of patients with spontaneous pneumothorax admitted in Abbasia Chest Hospital. Egypt J Bronchol 2016; 10:355.

    Article  Google Scholar 

  30. Thomas K, Naeem M, Reddy R. P173 ambulatory management of spontaneous pneumothorax. Thorax 2014;69:A150–A151.

    Article  Google Scholar 

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Correspondence to Maged Hassan MSc.

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Hassan, M., Shaarawy, H. Spontaneous pneumothorax: time to depart from the ‘chest tube underwater seal’?. Egypt J Bronchol 12, 137–141 (2018). https://doi.org/10.4103/ejb.ejb_58_17

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