Small Bore Thoracic Catheter Versus Chest Tube in Treatment of Primary Spontaneous Pneumothorax

Objective: The primary treatment of primary spontaneous pneumothorax (PSP) is still controversial. The large-bore thoracic catheter has traditionally been used, but there is now a global trend toward the increased use of the small-bore thoracic catheters (SBTC). The present study aims to compare the use of SBTC and chest tube (CT) in first-line treatment of PSP. Methods: This prospective randomized study included 90 patients diagnosed with PSP. The patients were randomly distributed into two groups. In the first group, catheter thoracostomy was applied with an 8 French thorax catheter and in the other group, a tube thoracostomy with a 28 French chest tube. The parameters used for comparison in this study were defined as pneumothorax side, pneumothorax size, pain, need of additional analgesia, malpositioning drain, duration of air leakage, duration of hospitalization, complications and recurrence. Results: In the evaluation of pain using the Numerical Rating Scale (NRS) at 1, 4, 12 and 24 hours after the application, the mean NRS values of the SBTC patients were seen to be lower than those of the CT patients but at 1, 12 and 24 hours, the difference was not statistically significant. At the 4th hour, the difference was determined to be statistically significant (p=0.022). The duration of air leakage was 1.7±1.4 days for the SBTC group and 2.2±1.9 days for the CT group. The period of termination of the drain was 3.3±1.2 days for the SBTC group and 4.0±1.7 days for the CT group. The duration of hospitalization was 3.5±1.3 days for the SBTC group and 4.5±1.9 days for the CT group. Conclusion: No significant difference was determined in respect of air leakage, hospital stay, failure rates or complications between the two procedures. When compared concerning postoperative pain, ease of application, patient comfort and incision scar, SBTC can be considered to be subjectively superior to CT, and can be used safely in the treatment of PSP.

Primer Spontan Pnömotoraks Tedavisinde Küçük Çaplı Toraks Katateri İle Toraks Dreni Uygulamasının Karşılaştırılması

Amaç: Primer spontan pnömotoraks primer tedavisi halen tartışmalıdır. Standart tedavi yaklaşımında geniş çaplı taraks drenleri kullanılmakla birlikte günümüzde global küçük çaplı toraks kateteri uygulaması yaygınlaşmaktadır. Çalışmamızda, primer spontan pnömotoraks ilk basamak tedavisinde küçük çaplı toraks kateteri (KÇTK) ile toraks dreni (TD) uygulamasının karşılaştırılması amaçlanmaktadır. Gereç ve Yöntem: Primer spontan pnömotoraks tanılı 90 olgu ileriye yönelik ve randomize olarak değerlendirmeye alındı. Olgular randomize olarak iki gruba ayrıldı. Bir gruba 8 french toraks kateteri, diğer gruba ise 28 french toraks dreni uygulandı. Her iki grup değerlendirilerek sonuçları kaydedildi. Değerlendirme kriterleri, pnömotoraks tarafı, pnömotoraks miktarı, ağrı, ek analjezi ihtiyacı, kateter ve dren malpozisyonu, hava kaçağı süresi, hastanede yatış süresi, komplikasyonları ve nüks idi. Bulgular: Ağrı için işlemi takiben 1., 4., 12. ve 24. saatlerde sayısal değerlendirme ölçeği (SDÖ) kullanılarak kaydedildi. Olguların 1., 12. ve 24. saatlerde kaydedilen ortalama SDÖ değerleri küçük çaplı toraks kateteri uygulananlarda daha düşük olarak izlendi fakat istatistiksel olarak anlamlı bulunmadı (p=0.274, 0.094 ve 0.082). Fakat dördüncü saatte yapılan ölçümde istatistiksel olarak anlamlı değerler kaydedildi (0.022). Hava kaçağı süresi KÇTK uygulanan olgularda 1.7±1.4 gün iken, TD uygulanan olgularda 2.2±1.9 gün olarak kaydedildi. Dren sonlandırma süresi KÇTK grubunda 3.3±1.2 gün ve TD grubunda 4.0±1.7 gün saptandı. Hastanede yatış süreleri ise KÇTK grubunda 3.5±1.3 gün iken, TD grubunda 4.5±1.9 idi. Sonuç: Her iki prosedürün karşılaştırılmasında, hava kaçağı süresi, hastanede yatış süresi, işlem başarısızlık oranları ve komplikasyonlar açısından istatistiksel anlamlı farklılık izlenmedi. İşlem sonrası ağrı, işlemin uygulama kolaylığı, hasta konforu, insizyon skarı gibi özellikleri açısından KÇTK subjektif olarak daha avantajlı ve primer spontan pnömotoraks tedavisinde güvenle kullanılabilen bir yöntem olarak değerlendirildi.

Kaynakça

1. Melton LJ 3rd, Hepper NG, Offord KP. Incidence of spontaneous pneumothorax in Olmsted County, Minnesota: 1950 to 1974. Am Rev Respir Dis 1979;120:1379–82.

2. Cho S, Lee EB. Management of primary and secondary pneumothorax using a small-bore thoracic catheter. Interact Cardiovasc Thorac Surg 2010;11:146–9.

3. Light RW. Pneumothorax. In: Pleural diseases. Baltimore: Williams & Wilkins; 2007. p. 306–39.

4. MacDuff A, Arnold A, Harvey J. Management of spontaneous pneumothorax: British Thoracic Society Pleural Disease Guideline 2010. Thorax 2010;65:18–31.

5. De Leyn P, Lismonde M, Ninane V, Noppen M, Slabbynck H, Van Meerhaeghe A, et al. Guidelines Belgian Society of Pneumology. Guidelines on the management of spontaneous pneumothorax. Acta Chir Belg 2005;105:265–7.

6. Baumann MH, Strange C. The clinician’s perspective on pneumothorax management. Chest 1997;112:822–8.

7. Ong ME, Chan YH, Kee TY, Chew HC, Koh MS. Spontaneous pneumothorax outcome study (Spot phase I): A 2-year review. Eur J Emerg Med 2004;11:89–94.

8. Mendis D, El-Shanawany T, Mathur A, Redington AE. Management of spontaneous pneumothorax: are British Thoracic Society guidelines being followed? Postgrad Med J 2002;78:80–4.

9. Türkyılmaz A, Erdem AF, Aydın Y, Çinici Ö, Eroğlu A. Sekonder Spontan Pnömotoraksta Tedavi: 100 Olguluk Tecrübe. [Article in Turkish]. Eurasian J Med 2007;39:97–102.

10. Demirhan R, Koşar A, Eryiğit H, Kıral H, Yıldırım M, Arman B. Spontaneous pneumothorax: retrospective analysis of 348 cases. [Article in Turkish]. Ulus Travma Acil Cerrahi Derg 2009;15:367–70.

11. Havelock T, Teoh R, Laws D, Gleeson F; BTS Pleural Disease Guideline Group. Pleural procedures and thoracic ultrasound: British Thoracic Society Pleural Disease Guideline 2010. Thorax 2010;65:ii61–76.

12. Conces DJ Jr, Tarver RD, Gray WC, Pearcy EA. Treatment of pneumothoraces utilizing small caliber chest tubes. Chest 1988;94:55–7.

13. Minami H, Saka H, Senda K, Horio Y, Iwahara T, Nomura F, et al. Small caliber catheter drainage for spontaneous pneumothorax. Am J Med Sci 1992;304:345–7.

14. Martin T, Fontana G, Olak J, Ferguson M. Use of pleural catheter for the management of simple pneumothorax. Chest 1996;110:1169–72.

15. Vedam H, Barnes DJ. Comparison of large and small-bore intercostal catheters in the management of spontaneous pneumothorax. Int Med J 2003;33:495–9.

16. Stolz A, Harustiak T, Pafko. P Spontaneous pneumothorax management. Eur Surg 2008;40:187–92.

17. Kuester JR, Frese S, Stein RM, Roth T, Beshay M, Schmid RA. Treatment of primary spontaneous pneumothorax in Switzerland: results of a survey. Interact Cardiovasc Thorac Surg 2006;5:139–44.

18. Cafarotti S, Dall’Armi V, Cusumano G, Margaritora S, Meacci E, Lococo F, et al. Small-bore wire-guided chest drains: safety, tolerability, and effectiveness in pneumothorax, malignant effusions, and pleural empyema. J Thorac Cardiovasc Surg 2011;141:683–7.

19. Pavlin DJ, Raghu G, Rogers TR, Cheney FW. Reexpansion hypotension. A complication of rapid evacuation of prolonged pneumothorax. Chest 1986;89:70–4.

20. Rozenman J, Yellin A, Simansky DA, Shiner RJ. Re-expansion pulmonary oedema following spontaneous pneumothorax. Respir Med 1996;90:235–8.

21. Palesty JA, McKelvey AA, Dudrick SJ. The efficacy of X-rays after chest tube removal. Am J Surg 2000;179:13–6.

22. Baumann MH. Management of spontaneous pneumothorax. Clin Chest Med 2006;27:369–81.

23. Delius RE, Obeid FN, Horst HM, Sorensen VJ, Fath JJ, Bivins BA. Catheter aspiration for simple pneumothorax. Experience with 114 patients. Arch Surg 1989;124:833–6.

24. Aplin P. Size does make a difference in management of spontaneous pneumothoraces. Emerg Med 1996;8:221–5.

25. Liu CM, Hang LW, Chen WK, Hsia TC, Hsu WH. Pigtail tube drainage in the treatment of spontaneous pneumothorax. Am J Emerg Med 2003;21:241–4.

Kaynak Göster

Southern Clinics of Istanbul Eurasia
  • ISSN: 2587-0998
  • Yayın Aralığı: Yılda 4 Sayı
  • Başlangıç: 2017

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