title: A prospective, randomised trial of pneumothorax therapy: manual aspiration versus conventional chest tube drainage.
abstract: BACKGROUND
  No consensus exists on the exact treatment of pneumothorax (PTX). Some guidelines are proposing manual aspiration (MA) to be preferred over tube thoracostomy (TT) in uncomplicated primary spontaneous pneumothorax (PSP). However, only a few studies reported a direct comparison of both methods. Our aim was to re-evaluate this with a randomised trial in a single centre in the Netherlands.
  
  
  METHODS
  Patients with a first episode of symptomatic PTX admitted to the ER or asymptomatic PTX with a size of ≥20% were recruited during 2007-2009 and followed-up for one year. Randomisation between MA and TT was balanced by a computer minimisation program for cause of PTX, smoking and gender. When first MA attempt failed, a second attempt was not undertaken and patients underwent TT. (registered at ClinicalTrials.gov (NCT00556335).
  
  
  RESULTS
  56 patients were included. Baseline characteristics were similar. Immediate success rates were 68.0% for MA versus 80.6% for TT (p = 0.28). Two week success rates were 100% in both groups. There was a significant difference in hospital stay in favour of MA: 2.4 ± 2.6 versus 4.4 ± 3.3 days (p = 0.02). One year recurrence rates in MA were lower than in TT, although not statistically significant (4.0% and 12.9% p = 0.37). Predictors of immediate success were traumatic PTX and female sex. One patient died during follow-up due to heart failure.
  
  
  CONCLUSIONS
  MA is simple, safe, cheap, minimal invasive in uncomplicated PSP/traumatic PTX with similar success and recurrence rates and a shorter hospital stay in comparison to TT and therefore the treatment of choice.
authors.affiliation: Isala klinieken, Department of Pulmonary Diseases, Groot Wezenland 20, 8011 JW Zwolle, The Netherlands. m.parlak@isala.nl
authors.forename: Mehmet
authors.initials: M
authors.lastname: Parlak
authors.forename: Steven M
authors.initials: SM
authors.lastname: Uil
authors.forename: Jan W K
authors.initials: JW
authors.lastname: van den Berg
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015505:Chest Tubes; D004322:Drainage / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011030:Pneumothorax / Q000628:therapy*; D011446:Prospective Studies; D013396:Suction / Q000379:methods; D016896:Treatment Outcome; D055815:Young Adult