Abstract
Secondary spontaneous pneumothorax (SSP) is traditionally managed with an intercostal chest tube attached to an underwater seal. We investigated whether use of a one-way flutter valve shortened patients’ length of stay (LoS).
This open-label randomised controlled trial enrolled patients presenting with SSP and randomised to either a chest tube and underwater seal (standard care: SC) or ambulatory care (AC) with a flutter valve. The type of flutter valve used depended on whether at randomisation the patient already had a chest tube in place: in those without a chest tube a pleural vent (PV) was used; in those with a chest tube in situ, an Atrium Pneumostat (AP) valve was attached. The primary end-point was LoS.
Between March 2017 and March 2020, 41 patients underwent randomisation: 20 to SC and 21 to AC (13=PV, 8=AP). There was no difference in LoS in the first 30 days following treatment intervention: AC (median=6 days, IQR 14.5) and SC (median=6 days, IQR 13.3). In patients treated with PV there was a high rate of early treatment failure (6/13; 46%), compared to patients receiving SC (3/20; 15%) (p=0.11) Patients treated with AP had no (0/8 0%) early treatment failures and a median LoS of 1.5 days (IQR 23.8).
There was no difference in LoS between ambulatory and standard care. Pleural Vents had high rates of treatment failure and should not be used in SSP. Atrium Pneumostats are a safer alternative, with a trend towards lower LoS.
Abstract
Ambulatory management with a flutter valve does not shorten overall length of stay in patients with secondary spontaneous pneumothoraces compared to standard management. This was due to increased risk of treatment failure with ambulatory management. https://bit.ly/2JEd3YC
Footnotes
This article has an editorial commentary: https://doi.org/10.1183/13993003.00003-2021
This article has supplementary material available from erj.ersjournals.com
This study is registered as a randomised controlled trial as ISRCTN79956557. Individual participant data that underlie the results reported in this articles after de-identification (text, tables, figures and appendices) will be available, along with the study protocol and statistical analysis plan, beginning 3 months and ending 36 months following article publication, to researchers who provide a methodologically sound proposal. Proposals should be directed to the corresponding author. To gain access, data requesters will need to sign a data access agreement.
Conflict of interest: S.P. Walker reports grants from Rocket Medical, during the conduct of the study.
Conflict of interest: E. Keenan has nothing to disclose.
Conflict of interest: O. Bintcliffe has nothing to disclose.
Conflict of interest: A.E. Stanton has nothing to disclose.
Conflict of interest: M. Roberts has nothing to disclose.
Conflict of interest: J. Pepperell has nothing to disclose.
Conflict of interest: I. Fairbairn has nothing to disclose.
Conflict of interest: E. McKeown has nothing to disclose.
Conflict of interest: J. Goldring has nothing to disclose.
Conflict of interest: N. Maddekar has nothing to disclose.
Conflict of interest: J. Walters has nothing to disclose.
Conflict of interest: A. West has nothing to disclose.
Conflict of interest: A. Bhatta has nothing to disclose.
Conflict of interest: M. Knight has nothing to disclose.
Conflict of interest: R. Mercer has nothing to disclose.
Conflict of interest: R. Hallifax has nothing to disclose.
Conflict of interest: P. White has nothing to disclose.
Conflict of interest: R.F. Miller reports personal fees for lectures from Gilead, outside the submitted work.
Conflict of interest: N.M. Rahman reports personal fees for consultancy from Rocket Medical, outside the submitted work.
Conflict of interest: N.A. Maskell reports grants from Rocket Medical, during the conduct of the study; personal fees from BD Carefusion and Cook Medical, outside the submitted work.
- Received September 16, 2020.
- Accepted November 30, 2020.
- Copyright ©ERS 2021. For reproduction rights and permissions contact permissions{at}ersnet.org
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