title: Heimlich valve in the management of pneumothorax in patients with advanced AIDS.
abstract: OBJECTIVE
  To review therapeutic strategies in the management of pneumothorax in patients with AIDS.
  
  
  METHODS
  Retrospective, 7-year, single institution experience.
  
  
  METHODS
  Forty-seven patients with AIDS were treated for 59 pneumothoraxes. Mean age was 37.4 years, and 70% of patients had prior or current infection with Pneumocystis carinii. All patients had CD4+ counts of < 100, and 28 of 47 patients (59.6%) had CD4+ counts of < 50. Of 59 pneumothoraxes, 14 pneumothoraxes (23.7%) were iatrogenic and 16 pneumothoraxes (27.1%) were bilateral. Patients were treated with conventional strategy (tube thoracostomy [TT] with or without pleurodesis, thoracotomy with blebectomy) or converted to a Heimlich valve (HV) in case of failure of conventional management.
  
  
  RESULTS
  Thirty-six of 47 patients (76.6%) were discharged, and only 26 of 36 patients (72.2%) had complete pneumothorax resolution at discharge after conventional treatment. All patients discharged with an HV (10 of 36 patients; 27.8%) had pneumothorax resolution followed by valve removal as outpatients. Mean hospital stay after chest decompression was 12 days for conventional-therapy group survivors and 3 days for patients treated with an HV. Thirteen patients died (27.7%) with follow-up to 60 days. In-hospital mortality was 23.4% (11 of 47 patients), which represented a 29.7% mortality for patients treated with conventional therapy. Patients treated with an HV had no in-hospital mortality and 100% pneumothorax resolution, with two deaths occurring within 60 days of discharge but after removal of the HV.
  
  
  CONCLUSIONS
  Patients with advanced AIDS and pneumothorax have high associated morbidity and mortality. If no resolution is observed after simple TT, prompt conversion to an HV allows safe and early hospital discharge.
authors.affiliation: Division of Cardiothoracic Surgery, The George Washington University Medical Center, Washington, DC 20422, USA.
authors.forename: L A
authors.initials: LA
authors.lastname: Vricella
authors.forename: G D
authors.initials: GD
authors.lastname: Trachiotis
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000150:complications; D000163:Acquired Immunodeficiency Syndrome / Q000150:complications*; D000328:Adult; D001983:Bronchial Fistula / Q000150:complications / Q000628:therapy; D015505:Chest Tubes; D004322:Drainage / Q000295:instrumentation*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010995:Pleural Diseases / Q000150:complications / Q000628:therapy; D018700:Pleurodesis; D011020:Pneumonia, Pneumocystis / Q000150:complications; D011030:Pneumothorax / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D016156:Respiratory Tract Fistula / Q000150:complications / Q000628:therapy; D013907:Thoracostomy