Management of primary spontaneous pneumothorax in teenagers: an 11‐year study

2021 ◽  
Author(s):  
E Benhaïm ◽  
B Roth ◽  
F Michel ◽  
T Merrot ◽  
JC Dubus
Keyword(s):  
Spontaneous Pneumothorax ◽  
Primary Spontaneous Pneumothorax

scholarly journals Bedside tracer gas technique accurately predicts outcome in aspiration of spontaneous pneumothorax

Thorax ◽  
2001 ◽  
Vol 56 (8) ◽  
pp. 617-621
Author(s):  
D G Kiely ◽  
S Ansari ◽  
W A Davey ◽  
V Mahadevan ◽  
G J Taylor ◽  
...  
Keyword(s):  
Chest Radiograph ◽  
Spontaneous Pneumothorax ◽  
Significant Risk ◽  
Admission Rate ◽  
Primary Spontaneous Pneumothorax ◽  
Tracer Gas ◽  
Secondary Spontaneous Pneumothorax ◽  
Poor Predictor ◽  
Bedside Test ◽  
Simple Bedside

BACKGROUNDThere is no technique in general use that reliably predicts the outcome of manual aspiration of spontaneous pneumothorax. We have hypothesised that the absence of a pleural leak at the time of aspiration will identify a group of patients in whom immediate discharge is unlikely to be complicated by early lung re-collapse and have tested this hypothesis by using a simple bedside tracer gas technique.METHODSEighty four episodes of primary spontaneous pneumothorax and 35 episodes of secondary spontaneous pneumothorax were studied prospectively. Patients breathed air containing a tracer (propellant gas from a pressurised metered dose inhaler) while the pneumothorax was aspirated percutaneously. Tracer gas in the aspirate was detected at the bedside using a portable flame ioniser and episodes were categorised as tracer gas positive (>1 part per million of tracer gas) or negative. The presence of tracer gas was taken to imply a persistent pleural leak. Failure of manual aspiration and the need for a further intervention was based on chest radiographic appearances showing either failure of the lung to re-expand or re-collapse following initial re-expansion.RESULTSA negative tracer gas test alone implied that manual aspiration would be successful in the treatment of 93% of episodes of primary spontaneous pneumothorax (p<0.001) and in 86% of episodes of secondary spontaneous pneumothorax (p=0.01). A positive test implied that manual aspiration would either fail to re-expand the lung or that early re-collapse would occur despite initial re-expansion in 66% of episodes of primary spontaneous pneumothorax and 71% of episodes of secondary spontaneous pneumothorax. Lung re-inflation on the chest radiograph taken immediately after aspiration was a poor predictor of successful aspiration, with lung re-collapse occurring in 34% of episodes by the following day such that a further intervention was required.CONCLUSIONSNational guidelines currently recommend immediate discharge of patients with primary spontaneous pneumothorax based primarily on the outcome of the post-aspiration chest radiograph which we have shown to be a poor predictor of early lung re-collapse. Using a simple bedside test in combination with the post-aspiration chest radiograph, we can predict with high accuracy the success of aspiration in achieving sustained lung re-inflation, thereby identifying patients with primary spontaneous pneumothorax who can be safely and immediately discharged home and those who should be observed overnight because of a significant risk of re-collapse, with an estimated re-admission rate of 1%.

Longer symptom onset to aspiration time predicts success of needle aspiration in primary spontaneous pneumothorax

Thorax ◽  
2019 ◽  
Vol 74 (8) ◽  
pp. 780-786 ◽  
Author(s):  
Constance Vuillard ◽  
Fadia Dib ◽  
Jallal Achamlal ◽  
Stéphane Gaudry ◽  
Damien Roux ◽  
...  
Keyword(s):  
Success Rate ◽  
Symptom Onset ◽  
Spontaneous Pneumothorax ◽  
Needle Aspiration ◽  
Primary Spontaneous Pneumothorax ◽  
Line Treatment ◽  
First Line ◽  
Discovery Phase ◽  
Registration Number ◽  
First Line Treatment

BackgroundNeedle aspiration (NA) is recommended as first-line treatment of primary spontaneous pneumothorax (PSP). We aimed to assess NA success and the effect of a longer symptom onset to NA time.MethodsA discovery phase was retrospectively conducted in the intensive care unit of Louis Mourier Hospital (January 2000 to December 2011) followed by a prospective validation cohort (January 2012 to August 2015). The primary outcome was immediate NA success defined by the absence of need for chest tube insertion within 24 hours of the procedure.ResultsIn the discovery phase, 130 patients were admitted for PSP and 98 had NA as first-line treatment (75%). The immediate success rate of NA was 34.7% and was higher when it was performed ≥48 hours after symptom onset (57.7% vs 25%; p=0.004). In the prospective cohort, 87 patients were admitted for PSP; 71 (82%) had NA as first-step treatment. The immediate success rate was 40.8%. NA was more successful when it was performed after 48 hours of symptoms’ onset (34.5% vs 7.1%; p=0.005). A delay between the first symptom and NA procedure ≥48 hours was associated with a higher success of NA (OR=13.54; 95% CI 1.37 to 133). A smaller pneumothorax estimated by Light’s index was associated with NA success (OR=0.95; 95% CI 0.92 to 0.98). To what extent some of these pneumothoraces would have had a spontaneous resolution remains unknown.ConclusionWhen managing PSP with NA, a longer symptom onset to NA time was associated with NA success.Trial registration numberNCT02528734.

scholarly journals Efficacy and safety of pleurectomy and wedge resection versus simple pleurectomy in patients with primary spontaneous pneumothorax

2019 ◽  
Vol 11 (12) ◽  
pp. 5502-5508
Author(s):  
Agata Dżeljilji ◽  
Krzysztof Karuś ◽  
Artur Kierach ◽  
Barbara Kazanecka ◽  
Wojciech Rokicki ◽  
...  
Keyword(s):  
Spontaneous Pneumothorax ◽  
Wedge Resection ◽  
Primary Spontaneous Pneumothorax ◽  
Efficacy And Safety

Fluorescein-enhanced Autofluorescence Thoracoscopy in Patients with Primary Spontaneous Pneumothorax and Normal Subjects

2006 ◽  
Vol 174 (1) ◽  
pp. 26-30 ◽  
Author(s):  
Marc Noppen ◽  
Tom Dekeukeleire ◽  
Shane Hanon ◽  
Grigoris Stratakos ◽  
Kayvan Amjadi ◽  
...  
Keyword(s):  
Spontaneous Pneumothorax ◽  
Normal Subjects ◽  
Primary Spontaneous Pneumothorax

Burden between Undersupply and Overtreatment in the Care of Primary Spontaneous Pneumothorax

2017 ◽  
Vol 66 (07) ◽  
pp. 575-582 ◽  
Author(s):  
Tobias Suttner ◽  
Reiner Neu ◽  
Tobias Potzger ◽  
Tamas Szöke ◽  
Christian Grosser ◽  
...  
Keyword(s):  
Risk Factors ◽  
Recurrence Rate ◽  
Spontaneous Pneumothorax ◽  
Conservative Therapy ◽  
Thoracoscopic Surgery ◽  
Free Time ◽  
Primary Spontaneous Pneumothorax ◽  
Treatment Groups ◽  
True Recurrence ◽  
First Recurrence

Background The optimal treatment of primary spontaneous pneumothorax (PSP) is still controversial. The purpose of this study was to analyze the incidence of recurrence, the recurrence-free time, and to identify risk factors for recurrence after PSP. Methods We performed a retrospective analysis of 135 patients with PSP who were treated either conservatively with a chest tube (n = 87) or surgically with video-assisted thoracoscopic surgery (VATS; n = 48) from January 2008 through December 2012. Results In this study, 101 (74.8%) male and 34 (25.2%) female patients were included with a mean age of 35.7 years. The indications for surgery included blebs/bullae in the radiological images (n = 20), persistent air leaks (n = 15), or the occupations/wishes of the patients (n = 13). A first ipsilateral recurrent pneumothorax (true recurrence) was observed in 31.1% of all patients (VATS: 6.25%, conservative: 44.8%). Including contralateral recurrence, the overall first recurrence rate was 41.3% (VATS: 14.6%, conservative: 57.5%). The recurrence-free time did not differ significantly between the treatment groups (p = 0.51), and most recurrences were observed within the first 6 months after PSP. Independent risk factors identified for the first recurrence were conservative therapy (p = 0.0001), the size of the PSP (conservative; p = 0.016), and a body mass index <17 (VATS; 0.022). The risk for second and third recurrences of PSP was 17.5 and 70%, respectively, for both treatment groups, but it was 100% after conservative therapy. Conclusion Surgery for PSP should be selected based on the risk factors and the patient's wishes to prevent first recurrences but also to avoid overtreatment. The treatment of first and subsequent PSP recurrences should be with surgery since conservative treatment is associated with a 100% recurrence rate.

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