title: Spontaneous pneumothorax. Comparison of thoracic drainage vs immediate or delayed needle aspiration.
abstract: In the first part of this study, 61 patients admitted for the first episode or the first recurrence of a spontaneous pneumothorax (SP) were randomly treated with thoracic drainage (TD; 28 patients) or with simple needle aspiration (NA; 33 patients). Success rate of therapy was significantly higher with TD than with NA (93%, CI 84 to 100 vs 67%, CI 51 to 83; p = 0.01). Hospital stay was similar between the two groups (7 +/- 4.6 vs 7 +/- 5.6 days), mainly because NA was delayed by 72 h in 26 patients. Recurrence rates at 3 months were 29% (CI 11 to 47%) after TD, and 14% (CI 0 to 29%) after NA (p > 0.20, NS). In the second part of the study, an additional population of 35 patients was treated by immediate NA, with a success rate of 68.5% (CI 53.5 to 83.5%), and a recurrence rate at 3 months of 30% (CI 10 to 50%). Taken together, our results indicate that NA may be proposed as a first-line treatment of SP, with a successful result in two thirds of patients and recurrence in one fifth of patients. In patients who do not heal with NA, a combined risk of TD failure and short-term recurrence of 50% may be an incentive for undelayed surgical procedures.
authors.affiliation: Medical Intensive Care Units, Centre Médico-Chirurgical de Bligny, Briis/forges, France.
authors.forename: P
authors.initials: P
authors.lastname: Andrivet
authors.forename: K
authors.initials: K
authors.lastname: Djedaini
authors.forename: J L
authors.initials: JL
authors.lastname: Teboul
authors.forename: L
authors.initials: L
authors.lastname: Brochard
authors.forename: D
authors.initials: D
authors.lastname: Dreyfuss
mesh_terms: D000293:Adolescent; D000328:Adult; D015505:Chest Tubes; D016009:Chi-Square Distribution; D004322:Drainage / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009339:Needles; D011030:Pneumothorax / Q000628:therapy*; D011446:Prospective Studies; D012008:Recurrence; D013396:Suction / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D013997:Time Factors