EBQ:Conservative versus interventional treatment for spontaneous pneumothorax: Difference between revisions
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==Clinical Question== | ==Clinical Question== | ||
*2020 study supports conservative therapy vs chest tube. <ref>[[EBQ:Conservative versus interventional treatment for spontaneous pneumothorax]]</ref> however there are issues with study including “significant drop out rate, the relatively large number of protocol violations, the large inferiority margins and the short intervention time.”<ref>https://www.stemlynsblog.org/jc-conservative-management-of-pneumothoraces/</ref> | |||
** Inclusion criteria | |||
***14 to 50 years of age | |||
***unilateral primary spontaneous pneumothorax of 32% or more on chest radiography according to the Collins method (sum of interpleural distances, >6 cm) | |||
** Exclusion criteria <ref>https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12611000184976</ref> | |||
***Secondary pneumothorax, defined as pneumothorax occurring in the setting of acute trauma (including iatrogenic) or underlying lung disease including but not limited to COPD, pulmonary fibrosis, TB, cystic fibrosis, lung cancer and asthma that requires regular preventative medication or has been symptomatic within the last two years | |||
***Previous spontaneous pneumothorax on the same side 3. Coexistent haemothorax (i.e. spontaneous haemopneumothorax) | |||
***Bilateral pneumothorax | |||
***Clinical instability suggesting tension pneumothorax; respiratory distress persisting despite oxygen and parenteral narcotic analgesia (RR >30/min or SpO2 <90%), SBP <90 mmHg, HR greater than or equal to SBP. | |||
***Pregnancy at time of enrolment | |||
***Social circumstances whereby the patient either does not have adequate support after discharge to re-attend hospital if required, or is unlikely to present for study follow up. | |||
***Air travel within the next 12 weeks if this cannot be deferred should the pneumothorax be slow to resolve" | |||
**Observed for a minimum of 4 hours then repeat chest X-ray. | |||
**Discharge if no supplementary oxygen and walking comfortably, | |||
**Chest tubes placed if: | |||
***clinically significant symptoms persisted despite adequate analgesia | |||
***chest pain or dyspnea prevented mobilization | |||
***patient was unwilling to continue with conservative treatment | |||
***the patient’s condition became physiologically unstable (systolic blood pressure of <90 mm Hg, heart rate in beats per minute greater than or equal to systolic blood pressure in millimeters of mercury, respiratory rate of >30 breaths per minute, or Spo2 of <90% while the patient was breathing ambient air) | |||
***repeat chest radiograph showed an enlarging pneumothorax along with physiological instability. | |||
==Conclusion== | ==Conclusion== | ||
Revision as of 22:54, 10 February 2020
incomplete Journal Club Article
Simon G.A. et. al. "Conservative versus Interventional Treatment for Spontaneous Pneumothorax". '. 2020. 382:405-415.
PubMed Full text
PubMed Full text
Clinical Question
- 2020 study supports conservative therapy vs chest tube. [1] however there are issues with study including “significant drop out rate, the relatively large number of protocol violations, the large inferiority margins and the short intervention time.”[2]
- Inclusion criteria
- 14 to 50 years of age
- unilateral primary spontaneous pneumothorax of 32% or more on chest radiography according to the Collins method (sum of interpleural distances, >6 cm)
- Exclusion criteria [3]
- Secondary pneumothorax, defined as pneumothorax occurring in the setting of acute trauma (including iatrogenic) or underlying lung disease including but not limited to COPD, pulmonary fibrosis, TB, cystic fibrosis, lung cancer and asthma that requires regular preventative medication or has been symptomatic within the last two years
- Previous spontaneous pneumothorax on the same side 3. Coexistent haemothorax (i.e. spontaneous haemopneumothorax)
- Bilateral pneumothorax
- Clinical instability suggesting tension pneumothorax; respiratory distress persisting despite oxygen and parenteral narcotic analgesia (RR >30/min or SpO2 <90%), SBP <90 mmHg, HR greater than or equal to SBP.
- Pregnancy at time of enrolment
- Social circumstances whereby the patient either does not have adequate support after discharge to re-attend hospital if required, or is unlikely to present for study follow up.
- Air travel within the next 12 weeks if this cannot be deferred should the pneumothorax be slow to resolve"
- Observed for a minimum of 4 hours then repeat chest X-ray.
- Discharge if no supplementary oxygen and walking comfortably,
- Chest tubes placed if:
- clinically significant symptoms persisted despite adequate analgesia
- chest pain or dyspnea prevented mobilization
- patient was unwilling to continue with conservative treatment
- the patient’s condition became physiologically unstable (systolic blood pressure of <90 mm Hg, heart rate in beats per minute greater than or equal to systolic blood pressure in millimeters of mercury, respiratory rate of >30 breaths per minute, or Spo2 of <90% while the patient was breathing ambient air)
- repeat chest radiograph showed an enlarging pneumothorax along with physiological instability.
- Inclusion criteria