Outpatient management of primary spontaneous pneumothorax in the emergency department of a community hospital using a small-bore catheter and a Heimlich valve.
OBJECTIVE
The objective was to assess the effectiveness of a small-bore catheter (8F) connected to a one-way Heimlich valve in the emergency department (ED)-based outpatient management of primary spontaneous pneumothorax (PSP).


METHODS
The authors conducted a structured chart audit in a retrospective case series of patients with PSP who were treated with a small-bore (8F) catheter and a Heimlich valve who were seen in the ED of a community hospital between April 2000 and March 2005. To be eligible, patients had to be available for a telephone interview. Main outcomes were success of treatment (sustained, complete lung reexpansion), admission, and surgical intervention rates. Secondary outcomes included number of chest x-rays (CXRs), number of visits to the ED, treatment duration, complications, and recurrence rates.


RESULTS
The authors identified 62 discrete episodes of PSP in 50 patients, with a mean (+/-standard deviation [SD]) age of 25.5 +/- 10.5 years (range = 14-53 years). In 50 of 62 episodes (81%, 95% confidence interval [CI] = 70.8% to 90.5%), patients were discharged directly from the ED. Patients were admitted to the hospital at some point for treatment in 27/62 episodes (43.5%, 95% CI = 31.2% to 55.9%). Surgery was performed for acute treatment failure in 17 episodes. Ultimately, 19 patients, who accounted for 21 of 62 episodes (33.9%, 95% CI = 22.1% to 45.6%), had surgery at some point in the study. Mean (+/-SD) time to admission for those patients initially discharged from the ED was 2.9 (+/-2.01) days (95% CI = 1.9 to 3.8 days). There were no serious complications from treatment; the minor complication rate (misplacement or dislodging of the chest tube) was 22.6% (95% CI = 12.2% to 33.0%). No association was found between the size of pneumothorax and treatment failure.


CONCLUSIONS
This study suggests that the initial management of PSP with a small-bore catheter and Heimlich valve can easily be performed by emergency physicians in the community hospital setting and appears safe. A larger study systematically comparing this approach with alternative therapies is needed.
University of Toronto Medical School Toronto, Ontario, Canada.
Behzad
B
Hassani
John
J
Foote
Bjug
B
Borgundvaag
D000293:Adolescent; D000328:Adult; D002404:Catheterization / Q000379:methods*; D015505:Chest Tubes; D016009:Chi-Square Distribution; D004636:Emergency Service, Hospital; D005260:Female; D006764:Hospitals, Community; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D009864:Ontario; D017063:Outcome Assessment, Health Care; D010044:Outpatient Clinics, Hospital; D011030:Pneumothorax / Q000628:therapy*; D012189:Retrospective Studies; D055815:Young Adult