Needle Aspiration Versus Closed Thoracostomy in the Treatment of Spontaneous Pneumothorax: A Meta-analysis.

PURPOSE: To compare the effectiveness and safety between needle aspiration (NA) and closed thoracostomy (CT) method in adult spontaneous pneumothorax (SP) patients and to explore the most effective and safe protocol by using meta-analysis method. MATERIALS AND METHODS: This study was based on Cochrane methodology for conducting meta-analysis. Only randomized controlled trials were eligible for this study. The participants were adults who had SP. The Review Manager Database was used to analyze selected studies. RESULTS: Nine RCTs involving 665 patients were included. Although the initial success rate of CT was higher, the two groups were not statistically significant (RR 0.87 [95% CI 0.76-1.00]; p = 0.05). Compared the NA group, the use of CT method to treat SP significantly increased complications (RR 0.17 [95% CI 0.06-0.45]; p = 0.0003) and operation rate (RR 0.57 [95% CI 0.35-0.95]; p = 0.03). There was no significant difference in the 1-week success rate, admitted rate, 3-month recurrence rate, 1-year recurrence rate, and recurrence time between the two groups. Subgroup analysis of primary spontaneous pneumothorax (PSP) and secondary spontaneous pneumothorax (SSP) patients showed that the initial success rate of the CT method was higher than NA group (RR 0.74 [95% CI 0.60-0.92]; p = 0.007). CONCLUSIONS: For the treatment of SP, NA method could significantly decrease complication rate, operation rate, as well as hospital stay length, compared with the CT method. Subgroup analysis indicated that the use of CT method in SSP and PSP patients might increase the initial success rate.

¿es seguro el manejo médico conservador no quirúrgico en pacientes con hemotórax traumático? / Is the non-surgical conservative medical management in patients with traumatic hemothorax secure?

RESUMEN El hemotórax se define como la presencia de una colección sanguínea en el espacio pleural. El objetivo de la investigación fue determinar si el manejo conservador no quirúrgico del hemotórax traumático es seguro. Se hizo un estudio descriptivo, prospectivo, de una cohorte de pacientes que ingresaron con diagnóstico de trauma torácico complicado con hemotórax, desde enero de 2013 hasta diciembre de 2016, en la unidad de cirugía de tórax del Hospital Dr. Adolfo Pons del Instituto Venezolano de los Seguros Sociales (IVSS) de Maracaibo, Venezuela. Se evaluaron 150 pacientes; la edad promedio fue de 30,9 años (rango entre 24-65 años), con predominio del sexo masculino (85,2%). En la mayoría de los casos, el traumatismo torácico fue no penetrante (60%) y las causas más frecuentes fueron heridas por proyectil de arma de fuego (48%), accidente de tránsito (26,6%) y heridas por arma blanca (25,3%). El hemitórax derecho fue el más afectado (53,3%); el volumen de sangre drenada se clasificó en leve (25,3%), moderada (70,6%) y masiva (3,9%). El tratamiento efectuado de primera intención en el 80% de los casos fue la toracotomía cerrada con sonda pleural (tubo 24 Fr). Sin embargo, en el 13,3% de los pacientes fue necesario realizar cirugía abierta sobre el espacio pleural (toracotomía exploradora). La evolución de los pacientes fue satisfactoria en el 100% de los casos. Conclusión: La toracotomía cerrada con sondaje pleural juega un papel básico en el tratamiento no quirúrgico inicial, siendo un procedimiento conservador seguro en estos pacientes, pero donde se debe tener en cuenta las condiciones clínicas del paciente, a fin de disminuir complicaciones y las muertes asociadas.

ABSTRACT The hemothorax is defined as the presence of a collection of blood in the pleural space. The objective of this research was to determine if conservative nonsurgical management of traumatic hemothorax is safe. A descriptive and prospective study of a cohort of patients admitted with a diagnosis of chest trauma complicated with hemothorax was carried out from January 2013 to December 2016, in the Thorax Surgery Unit at the Hospital Dr. Adolfo Pons of the Instituto Venezolano de los Seguros Sociales (IVSS) in Maracaibo, Venezuela. A total of 150 patients were evaluated, the mean age was 30.9 years (range 24-65 years), with a predominance in males 85.2%. In most cases, the thoracic trauma was non-penetrating (60%), and the most frequent cause was bullet wounds (48%), car accident (26.6%), and bladed weapon wounds (25.3%). The right hemithorax was the most affected (53.3%). The volume of drained blood was classified in mild (25.3%), moderate (70.6%) and massive (3.9%). The treatment carried out in the first intention, in the 80% of the cases, was closed thoracostomy with a pleural catheter (24 Fr). However, in 13.3% of patients, it was necessary to perform open surgery on the pleural space (exploratory thoracostomy). The evolution of the patients was satisfactory in a 100% of the cases. Conclusion: The closed thoracostomy with pleural catheter plays a basic role in the initial nonsurgical treatment, being a safe, conservative procedure in these patients. However, the patient clinical condition should be taken into account to decrease complications and associated deaths.

Cardiopulmonary Resuscitation for Tension Pneumothorax during Ventilating Bronchosocpy / 대한마취과학회지

Tension pneumothorax is a rare complication during anesthesia and ventilating bronchoscopy. The authors have experienced a case of tension pneumothorax during ventilating bronchoscopy for removal of a foreign body(peanut) in the left mian bronches which caused cardiac arrest in a 22 month old pt. The patients was successfully resuscitated by CPR and closed thoracostomy. Subsequently the foreigh body was removed by bronchotomy.