title: Outcome of spontaneous and iatrogenic pneumothoraces managed with small-bore chest tubes.
abstract: BACKGROUND
  Little is known about the efficacy of management of iatrogenic pneumothoraces with small-bore chest tubes. The aim of this study was to assess the outcome of iatrogenic pneumothoraces requiring drainage managed with a small-bore chest tube and to compare the results to spontaneous pneumothoraces treated in the same unit with the same device. The primary outcome was requirement of video-assisted thoracoscopic surgery for drainage failure; secondary outcomes were length of drainage and number of inserted chest tubes.
  
  
  METHODS
  Patients with pneumothorax admitted between 1997 and 2007 were retrospectively identified. Traumatic pneumothoraces and those occurring under mechanical ventilation were excluded. All pneumothoraces were drained using the same small-bore chest tube (8 French) according to our local protocol.
  
  
  RESULTS
  Five hundred sixty-one pneumothoraces were analysed, 431 (76.8%) were spontaneous pneumothoraces and 130 (23.2%) were iatrogenic. Iatrogenic pneumothoraces were associated with less requirement of video-assisted thoracoscopic surgery for drainage failure [adjusted odds ratio= 0.24 (0.04, 0.86)]. Length of drainage of iatrogenic pneumothoraces was longer than for primary spontaneous pneumothoraces (3.8 ± 3.1 vs. 2.7 ± 1.8 days, P < 0.001) and shorter than for secondary spontaneous pneumothoraces (4.6 ± 2.3 days, P = 0.004). Number of inserted chest tubes per patient was not significantly different according to pneumothoraces' aetiology.
  
  
  CONCLUSIONS
  Small-bore chest tubes are feasible for treatment of iatrogenic pneumothoraces and have a better rate of success and slightly longer drainage duration than when used for spontaneous pneumothoraces.
authors.affiliation: AP-HP, Hôpital Saint-Antoine, Service de Réanimation Médicale, Paris, France. galbois@gmail.com
authors.forename: A
authors.initials: A
authors.lastname: Galbois
authors.forename: L
authors.initials: L
authors.lastname: Zorzi
authors.forename: S
authors.initials: S
authors.lastname: Meurisse
authors.forename: S
authors.initials: S
authors.lastname: Kernéis
authors.forename: D
authors.initials: D
authors.lastname: Margetis
authors.forename: M
authors.initials: M
authors.lastname: Alves
authors.forename: H
authors.initials: H
authors.lastname: Ait-Oufella
authors.forename: J-L
authors.initials: JL
authors.lastname: Baudel
authors.forename: G
authors.initials: G
authors.lastname: Offenstadt
authors.forename: E
authors.initials: E
authors.lastname: Maury
authors.forename: B
authors.initials: B
authors.lastname: Guidet
mesh_terms: D000328:Adult; D015505:Chest Tubes; D015331:Cohort Studies; D004322:Drainage / Q000295:instrumentation; D005260:Female; D006801:Humans; D007049:Iatrogenic Disease; D008297:Male; D008875:Middle Aged; D011030:Pneumothorax / Q000601:surgery*; D012189:Retrospective Studies; D020775:Thoracic Surgery, Video-Assisted; D016896:Treatment Outcome