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.

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.

Citation

Walker, S. P., Keenan, E., Bintcliffe, O., Stanton, A. E., Roberts, M., Pepperell, J., …Maskell, N. A. (2021). Ambulatory management of secondary spontaneous pneumothorax: A randomised controlled trial. European Respiratory Journal, 57(6), Article 2003375. https://doi.org/10.1183/13993003.03375-2020

• 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