title: Outpatient treatment of primary spontaneous pneumothorax using a small-bore chest drain with a Heimlich valve:  the experience of a Singapore emergency department.
abstract: OBJECTIVE
  To review the outcomes and safety profile of small-bore (8 Fr) chest drains with a Heimlich valve for the treatment of primary spontaneous pneumothorax.
  
  
  METHODS
  A retrospective casenotes review was carried out for pneumothorax cases treated with a small-bore chest drain and connected to a Heimlich valve in the emergency department during a 14-month period from 1 August 2009 to 30 September 2010. Inclusion criteria were primary spontaneous pneumothorax, first episode, unilateral, at least 2-cm rim of air and no or minimal associated pleural effusion. Exclusion criterion was tension pneumothorax. Key outcomes studied were the success rate, as defined by sustained, complete lung re-expansion without the need for alternative intervention (e.g. conventional chest tube or surgery) or admission and complication rates.
  
  
  RESULTS
  A total of 55 patients fulfilled the inclusion criteria and were treated with an 8 Fr chest tube and a Heimlich valve. The study population was predominantly (87.3%) male. The age range was 14-48 years (median 20). The overall success rate (as defined above) was 65.5% [95% confidence interval (CI): 51.4-77.8%]. The rate of surgical pleurodesis was 23.6% (95% CI: 13.2-37%). Complications encountered were tube blockage by haemoserous discharge (1.8%; 95% CI: 0-9.7%) and tube dislodgement (5.5%; 95% CI: 1.1-15.1%).
  
  
  CONCLUSIONS
  Our results suggest that the use of a small-bore chest drain and a Heimlich valve is a safe and efficacious mode of treatment for primary spontaneous pneumothorax, which enables management of the majority of these patients as outpatients.
authors.affiliation: Department of Accident and Emergency, Changi General Hospital, 2 Simei Street, Singapore. shieh_mei_lai@cgh.com.sg
authors.forename: Shieh Mei
authors.initials: SM
authors.lastname: Lai
authors.forename: Augustine Kim Huat
authors.initials: AK
authors.lastname: Tee
mesh_terms: D000293:Adolescent; D000328:Adult; D002404:Catheterization / Q000295:instrumentation / Q000379:methods*; D015505:Chest Tubes / Q000706:statistics & numerical data*; D004322:Drainage / Q000295:instrumentation / Q000379:methods; D004636:Emergency Service, Hospital; D004867:Equipment Design; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010044:Outpatient Clinics, Hospital; D010045:Outpatients / Q000706:statistics & numerical data; D011030:Pneumothorax / Q000453:epidemiology / Q000628:therapy*; D012846:Singapore; D016896:Treatment Outcome; D055815:Young Adult