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Comparative Study
. 2014 Dec 18;2014(12):CD010565.
doi: 10.1002/14651858.CD010565.pub2.

Conservative versus interventional management for primary spontaneous pneumothorax in adults

Michael Ashby  1 , Greg Haug, Pete Mulcahy, Kathryn J Ogden, Oliver Jensen, Julia A E Walters
Affiliations
Comparative Study

Conservative versus interventional management for primary spontaneous pneumothorax in adults

Michael Ashby et al. Cochrane Database Syst Rev. .

Abstract

Background: Primary spontaneous pneumothorax is widely managed according to size with interventional techniques based on practice guidelines. Interventional management is not without complications and observational data suggest conservative management works. The current guidelines are based on expert consensus rather than evidence, and a systematic review may help in identifying evidence for this practice.

Objectives: The objective of the review is to compare conservative and interventional treatments of adult primary spontaneous pneumothorax for outcomes of clinical efficacy, tolerability and safety.

Search methods: We searched the Cochrane Central Register of Controlled Trials (CENTRAL), (The Cochrane Library, Issue 6, 2014); MEDLINE via Ovid SP (1920 to 26th June 2014); EMBASE via Ovid SP (1947 to 26th June 2014); CINAHL via EBSCO host (1980 to 26th June 2014); and ISI Web of Science (1945 to 26th June 2014). We searched ongoing trials via the relevant databases and contacted authors. We also searched the 'grey literature'.

Selection criteria: We included randomized controlled trials (RCTs) and we accepted quasi-RCTs if a systematic method of allocation was used. Participants were limited to adults aged 18 to 50 years, with their first symptomatic primary spontaneous pneumothorax with radiological evidence and no underlying lung disease.

Data collection and analysis: Two of five authors independently reviewed all studies in the search criteria and made inclusions and exclusions according to the selection criteria. No statistical methods were necessary as there were no included trials.

Main results: We identified 358 studies with duplicates removed. There were three potentially relevant studies that we excluded as they were not randomized controlled trials. There was one ongoing trial that was relevant and we contacted the authors and confirmed the study is ongoing at June 2014. We will update this review when this ongoing study is completed.

Authors' conclusions: There are no completed randomized controlled trials comparing conservative and interventional management for primary spontaneous pneumothorax in adults. There is a lack of high-quality evidence for current guidelines in management and a need for randomized controlled trials comparing conservative and interventional management for this condition.

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Conflict of interest statement

Michael Ashby: none known Greg Haug: none known Pete Mulcahy: none known Kathryn J Ogden: none known Oliver Jensen: none known Julia Walters: none known

Figures

1
1
Study flow diagram.
See this image and copyright information in PMC

Update of

  • doi: 10.1002/14651858.CD010565

References

References to studies excluded from this review

Brown 2014 {published data only}
    1. Brown SG, Ball EL, Macdonald SP, Wright C, McD Taylor D. Spontaneous pneumothorax; a multicentre retrospective analysis of emergency treatment, complications and outcomes. Internal Medicine Journal 2014;44(5):450‐7. - PubMed
Massongo 2014 {published data only}
    1. Massongo M, Leroy S, Scherpereel A, Vaniet F, Dhalluin X, Chahine B, et al. Outpatient management of primary spontaneous pneumothorax: a prospective study. The European Respiratory Journal 2014;43(2):582‐90. - PubMed
Schramel 1996 {published data only}
    1. Schramel FM, Sutedja TG, Braber JC, Mourik JC, Postmus PE. Cost‐effectiveness of video‐assisted thoracoscopic surgery versus conservative treatment for first time or recurrent spontaneous pneumothorax. The European Respiratory Journal 1996;9(9):1821‐5. [PUBMED: 8880097] - PubMed

References to ongoing studies

ANZCTR336270 {unpublished data only}
    1. A study to investigate the treatment of pneumothorax (collapsed lung). Ongoing study 14th July 2011; proposed sample size 342.

Additional references

Ball 2007
    1. Ball CG, Lord J, Laupland KB, Gmora S, Mulloy RH, Ng AK, et al. Chest tube complications: how well are we training our residents?. Canadian Journal of Surgery. Journal Canadien de Chirurgie 2007;50(6):450‐8. [PUBMED: 18053373] - PMC - PubMed
Baumann 2001
    1. Baumann MH, Strange C, Heffner JE, Light R, Kirby TJ, Klein J, et al. Management of spontaneous pneumothorax: an American College of Chest Physicians Delphi consensus statement. Chest 2001;119(2):590‐602. [PUBMED: 11171742] - PubMed
Bense 1987
    1. Bense L, Eklund G, Wiman LG. Smoking and the increased risk of contracting spontaneous pneumothorax. Chest 1987;92(6):1009‐12. [PUBMED: 3677805] - PubMed
Cliff 1957
    1. Cliff JM. Spontaneous pneumothorax in the Royal Navy. Proceedings of the Royal Society of Medicine 1957;50(7):517‐26. - PMC - PubMed
De Leyn 2005
    1. Leyn P, Lismonde M, Ninane V, Noppen M, Slabbynck H, Meerhaeghe A, et al. Guidelines Belgian Society of Pneumology. Guidelines on the management of spontaneous pneumothorax. Acta Chirurgica Belgica 2005;105(3):265‐7. [PUBMED: 16018518] - PubMed
Gupta 2000
    1. Gupta D, Hansell A, Nichols T, Duong T, Ayres JG, Strachan D. Epidemiology of pneumothorax in England. Thorax 2000;55(8):666‐71. [PUBMED: 10899243] - PMC - PubMed
Henry 2003
    1. Henry M, Arnold T, Harvey J. BTS guidelines for the management of spontaneous pneumothorax. Thorax 2003;58 Suppl 2:ii39‐52. [PUBMED: 12728149] - PMC - PubMed
Higgins 2002
    1. Higgins J, Thompson S, Deeks J, Altman D. Statistical heterogeneity in systematic reviews of clinical trials: a critical appraisal of guidelines and practice. Journal of Health Services Research Policy 2002;7(1):51‐61. [PUBMED: 11822262] - PubMed
Higgins 2011
    1. Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011] . The Cochrane Collaboration, 2011. Available from www.cochrane‐handbook.org.
Kelly 2007
    1. Kelly AM. Review of management of primary spontaneous pneumothorax: is the best evidence clearer 15 years on?. Emergency Medicine Australasia 2007;19(4):303‐8. - PubMed
Kircher 1954
    1. Kircher LT Jr, Swartzel RL. Spontaneous pneumothorax and its treatment. JAMA 1954;155(1):24‐9. [PUBMED: 13151882] - PubMed
Light 2007
    1. Light R. Pleural Disease. Oxford UK: Blackwell Publishing Ltd, 2007.
MacDuff 2010
    1. MacDuff A, Arnold A, Harvey J. Management of spontaneous pneumothorax: British Thoracic Society Pleural Disease Guideline 2010. Thorax 2010;65 Suppl 2:ii18‐31. [PUBMED: 20696690] - PubMed
Melton 1979
    1. Melton LJ 3rd, Hepper NG, Offord KP. Incidence of spontaneous pneumothorax in Olmsted County, Minnesota: 1950 to 1974. The American Review of Respiratory Disease 1979;120(6):1379‐82. [PUBMED: 517861] - PubMed
O'Rourke 1989
    1. O'Rourke JP, Yee ES. Civilian spontaneous pneumothorax. Treatment options and long‐term results. Chest 1989;96(6):1302‐6. - PubMed
RevMan 5.3 [Computer program]
    1. The Nordic Cochrane Centre, The Cochrane Collaboration. Review Manager (RevMan). Version 5.3. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2014.
Romanoff 1968
    1. Romanoff H. Management of spontaneous pneumothorax. American Journal of Surgery 1968;115(3):329‐32. [PUBMED: 5643226] - PubMed
Ruckley 1966
    1. Ruckley CV, McCormack RJ. The management of spontaneous pneumothorax. Thorax 1966;21(2):139‐44. - PMC - PubMed
Sahn 2000
    1. Sahn SA, Heffner JE. Spontaneous pneumothorax. The New England Journal of Medicine 2000;342(12):868‐74. [PUBMED: 10727592] - PubMed
Seremetis 1970a
    1. Seremetis MG. The management of spontaneous pneumothorax. Chest 1970;57(1):65‐8. - PubMed
Stradling 1966
    1. Stradling P, Poole G. Conservative management of spontaneous pneumothorax. Thorax 1966;21(2):145‐9. [PUBMED: 5935842] - PMC - PubMed
Vedam 2003
    1. Vedam H, Barnes DJ. Comparison of large‐ and small‐bore intercostal catheters in the management of spontaneous pneumothorax. Internal Medicine Journal 2003;33(11):495‐9. [PUBMED: 14656251] - PubMed
Wakai 2007
    1. Wakai A, O'Sullivan RG, McCabe G. Simple aspiration versus intercostal tube drainage for primary spontaneous pneumothorax in adults. Cochrane Database of Systematic Reviews 2007, Issue 1. [DOI: 10.1002/14651858.CD004479.pub2] - DOI - PubMed

References to other published versions of this review

Ashby 2013
    1. Ashby M, Haug G, Mulcahy P, Ogden KJ, Jensen O. Conservative versus interventional management for primary spontaneous pneumothorax in adults. Cochrane Database of Systematic Reviews 2013, Issue 6. [DOI: 10.1002/14651858.CD010565] - DOI - PMC - PubMed

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