title: The frequency of reexpansion pulmonary edema after trocar and hemostat assisted thoracostomy in patients with spontaneous pneumothorax.
abstract: OBJECTIVE
  Several risk factors for development of reexpansion pulmonary edema (REPE) after drainage of pneumothoraces have been reported, but the association between the method of thoracostomy and the development of REPE is unknown. The aim of this study was to compare the frequency of REPE after treatment of spontaneous pneumothorax with trocar or hemostat assisted closed thoracostomy.
  
  
  METHODS
  We performed a prospective, observational study including 173 patients with spontaneous pneumothorax who visited the emergency department from January 2007 to December 2008. In 2007, patients were treated with hemostat-assisted drainage, whereas patients in 2008 were treated with trocar-assisted drainage. The main outcome was the development of REPE, determined by computed tomography of the chest 8 hours after closed thoracostomy. Outcomes in both groups were compared using univariate and multivariate analyses.
  
  
  RESULTS
  Ninety-two patients were included, 48 (42 males) of which underwent hemostat-assisted drainage and 44 (41 males) underwent trocar-assisted drainage. The groups were similar in mean age (24 ± 10 vs. 26 ± 14 respectively). The frequencies of REPE after hemostat- and trocar-assisted drainage were 63% (30 patients) and 86% (38 patients) respectively (p=0.009). In multivariate analysis, trocar-assisted drainage was the major contributing factor for developing REPE (odds ratio=5.7, 95% confidence interval, 1.5-21). Age, gender, size of pneumothorax, symptom duration and laboratory results were similar between the groups.
  
  
  CONCLUSIONS
  Closed thoracostomy using a trocar is associated with an increased risk of REPE compared with hemostat- assisted drainage in patients with spontaneous pneumothorax.
authors.affiliation: Department of Emergency Medicine, Wonju College of Medicine, Yonsei University, Wonju, Korea.
authors.forename: Kyoung Chul
authors.initials: KC
authors.lastname: Cha
authors.forename: Hyun
authors.initials: H
authors.lastname: Kim
authors.forename: Ho Jin
authors.initials: HJ
authors.lastname: Ji
authors.forename: Woo Cheol
authors.initials: WC
authors.lastname: Kwon
authors.forename: Hyung Jin
authors.initials: HJ
authors.lastname: Shin
authors.forename: Yong Sung
authors.initials: YS
authors.lastname: Cha
authors.forename: Kang Hyun
authors.initials: KH
authors.lastname: Lee
authors.forename: Sung Oh
authors.initials: SO
authors.lastname: Hwang
authors.forename: Christopher C
authors.initials: CC
authors.lastname: Lee
authors.forename: Adam J
authors.initials: AJ
authors.lastname: Singer
mesh_terms: D000328:Adult; D005260:Female; D006489:Hemostatic Techniques; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D011030:Pneumothorax / Q000150:complications* / Q000601:surgery*; D011446:Prospective Studies; D011654:Pulmonary Edema / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery*; D012307:Risk Factors; D013525:Surgical Instruments; D013907:Thoracostomy / Q000009:adverse effects* / Q000379:methods*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult