Steven P. Walker
Ambulatory management of secondary spontaneous pneumothorax: A randomised controlled trial
Walker, Steven P.; Keenan, Emma; Bintcliffe, Oliver; Stanton, Andrew E.; Roberts, Mark; Pepperell, Justin; Fairbairn, Ian; McKeown, Edward; Goldring, James; Maddekar, Nadeem; Walters, James; West, Alex; Bhatta, Amrithraj; Knight, Matthew; Mercer, Rachel; Hallifax, Rob; White, Paul; Miller, Robert F.; Rahman, Najib M.; Maskell, Nick A.
Authors
Emma Keenan
Oliver Bintcliffe
Andrew E. Stanton
Mark Roberts
Justin Pepperell
Ian Fairbairn
Edward McKeown
James Goldring
Nadeem Maddekar
James Walters
Alex West
Amrithraj Bhatta
Matthew Knight
Rachel Mercer
Rob Hallifax
Paul White Paul.White@uwe.ac.uk
Professor in Applied Statistics
Robert F. Miller
Najib M. Rahman
Nick A. Maskell
Abstract
Secondary spontaneous pneumothorax (SSP) is traditionally managed with an intercostal chest tube attached to an underwater seal. We investigated whether use of a one-way flutter valve shortened patients' length of stay (LoS). This open-label randomised controlled trial enrolled patients presenting with SSP and randomised to either a chest tube and underwater seal (standard care: SC) or ambulatory care (AC) with a flutter valve. The type of flutter valve used depended on whether at randomisation the patient already had a chest tube in place: in those without a chest tube a pleural vent (PV) was used; in those with a chest tube in situ, an Atrium Pneumostat (AP) valve was attached. The primary end-point was LoS. Between March 2017 and March 2020, 41 patients underwent randomisation: 20 to SC and 21 to AC (13=PV, 8=AP). There was no difference in LoS in the first 30 days following treatment intervention: AC (median=6 days, IQR 14.5) and SC (median=6 days, IQR 13.3). In patients treated with PV there was a high rate of early treatment failure (6/13; 46%), compared to patients receiving SC (3/20; 15%) (p=0.11) Patients treated with AP had no (0/8 0%) early treatment failures and a median LoS of 1.5 days (IQR 23.8). There was no difference in LoS between ambulatory and standard care. Pleural Vents had high rates of treatment failure and should not be used in SSP. Atrium Pneumostats are a safer alternative, with a trend towards lower LoS.
Journal Article Type | Article |
---|---|
Acceptance Date | Nov 30, 2020 |
Online Publication Date | Jun 24, 2021 |
Publication Date | Jun 1, 2021 |
Deposit Date | Dec 7, 2020 |
Publicly Available Date | Jun 2, 2022 |
Journal | European Respiratory Journal |
Print ISSN | 0903-1936 |
Electronic ISSN | 1399-3003 |
Publisher | European Respiratory Society |
Peer Reviewed | Peer Reviewed |
Volume | 57 |
Issue | 6 |
Article Number | 2003375 |
DOI | https://doi.org/10.1183/13993003.03375-2020 |
Public URL | https://uwe-repository.worktribe.com/output/6912932 |
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Ambulatory Management Of Secondary Spontaneous Pneumothorax: A Randomised Controlled Trial
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This is an author-submitted, peer-reviewed version of an article that has been accepted for publication in the European Respiratory Journal, prior to copy-editing, formatting and typesetting. This version of the article may not be duplicated or reproduced without prior permission from the copyright owner, the European Respiratory Society. The publisher is not responsible or liable for any errors or omissions in this version of the article or in any version derived from it by any other parties. The final, copy-edited, published article, which is the version of record, is available online from the European Respiratory Journal without a subscription 12 months after the date of issue publication
Ambulatory Management Of Secondary Spontaneous Pneumothorax: A Randomised Controlled Trial
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Licence
http://www.rioxx.net/licenses/all-rights-reserved
Publisher Licence URL
http://www.rioxx.net/licenses/all-rights-reserved
Copyright Statement
This is an author-submitted, peer-reviewed version of an article that has been accepted for publication in the European Respiratory Journal, prior to copy-editing, formatting and typesetting. This version of the article may not be duplicated or reproduced without prior permission from the copyright owner, the European Respiratory Society. The publisher is not responsible or liable for any errors or omissions in this version of the article or in any version derived from it by any other parties. The final, copy-edited, published article, which is the version of record, is available online from the European Respiratory Journal without a subscription 12 months after the date of issue publication
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