Abstract
Introduction: No large RCTs compare different treatment strategies in management of primary(PSP) and secondary spontaneous pneumothorax(SSP). We aimed to review efficacy of small bore(12-18 Fr.) intercostal tube(ICT) via Seldinger technique versus large bore 'surgical' ICT via blunt dissection. We also compared outcome measures between apical and basal ICT.
Methods: Retrospective observational study of 212 consecutive pneumothorax episodes between January and December 2012. Iatrogenic and traumatic pneumothorax were excluded. Patient case notes and plain chest radiographs were reviewed. P value of <0.05 was considered significant.
Results: Of the 212 episodes, 51(33%) had PSP and 30(19%) SSP. 46 patients had small bore ICT and 13 large bore ICT. 16 patients had apical ICT and 23 basal. There was no statistical difference in terms of demographic data and type and size of pneumothorax in either group. Large bore ICT group had significantly higher length of stay(LOS) compared to small bore ICT (16 days versus 8.5 days; p=0.04). However, non-significant lower success rate, longer duration of ICT and comparable rate of complications and recurrence was observed in large bore ICT (p>0.05). Regarding ICT placement site, no significant difference was observed in outcomes between apical and basal ICT (p>0.05).
Conclusion: Our data has shown that small bore ICT perform better and basal ICT were as effective as apical in management of SP. RCT evidence in this field is limited and total sample size is too small to make any firm conclusions.
- © 2014 ERS