Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2017 Jun 22;12(6):e0178802.
doi: 10.1371/journal.pone.0178802. eCollection 2017.

Systematic review and meta-analysis of initial management of pneumothorax in adults: Intercostal tube drainage versus other invasive methods

Min Joung Kim  1 , Incheol Park  1 , Joon Min Park  2 , Kyung Hwan Kim  2 , Junseok Park  2 , Dong Wun Shin  2
Affiliations
Meta-Analysis

Systematic review and meta-analysis of initial management of pneumothorax in adults: Intercostal tube drainage versus other invasive methods

Min Joung Kim et al. PLoS One. .

Abstract

Objectives: The ideal invasive management as initial approach for pneumothorax (PTX) is still under debate. The purpose of this systematic review and meta-analysis was to examine the evidence for the effectiveness of intercostal tube drainage and other various invasive methods as the initial approach to all subtypes of PTX in adults.

Methods: Three databases were searched from inception to May 29, 2016: MEDLINE, EMBASE, and the Cochrane CENTRAL. Randomised controlled trials that evaluated intercostal tube drainage as the control and various invasive methods as the intervention for the initial approach to PTX in adults were included. The primary outcome was the early success rate of each method, and the risk ratios (RRs) were used for an effect size measure. The secondary outcomes were recurrence rate, hospitalization rate, hospital stay, and complications.

Results: Seven studies met our inclusion criteria. Interventions were aspiration in six studies and catheterization connected to a one-way valve in one study. Meta-analyses were conducted for early success rate, recurrence rate, hospitalization rate, and hospital stay. Aspiration was inferior to intercostal tube drainage in terms of early success rate (RR = 0.82, confidence interval [CI] = 0.72 to 0.95, I2 = 0%). While aspiration and intercostal tube drainage showed no significant difference in the recurrence rate (RR = 0.84, CI = 0.57 to 1.23, I2 = 0%), aspiration had shorter hospital stay than intercostal tube drainage (mean difference = -1.73, CI = -2.33 to -1.13, I2 = 0%). Aspiration had lower hospitalization rate than intercostal tube drainage, but marked heterogeneity was present (RR = 0.38, CI = 0.19 to 0.76, I2 = 85%).

Conclusion: Aspiration was inferior to intercostal tube drainage in terms of early resolution, but it had shorter hospital stay. The recurrence rate of aspiration and intercostal tube drainage did not differ significantly. The efficacy of catheterization connected to a one-way valve was inconclusive because of the small number of relevant studies. (Registration of study protocol: PROSPERO, CRD42016037866).

PubMed Disclaimer

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Flow diagram showing selection of studies for review.
Fig 2
Fig 2. Meta-analysis of the early success rate associated with the aspiration versus intercostal tube drainage.
The risk ratio for early success rate was used for effect size measure. The Mantel-Haenzel method and a random-effects model were used for calculating the pooled estimate.
Fig 3
Fig 3. Subgroup analysis of the studies that compared aspiration and intercostal tube drainage.
The subgroupings were assigned according to the subtype of pneumothorax included in each study; i.e., first episode of primary spontaneous pneumothorax versus other types.
Fig 4
Fig 4. Meta-analysis of the recurrence rate within 1 year associated with aspiration versus intercostal tube drainage.
Fig 5
Fig 5. Meta-analysis of the hospitalization rate associated with aspiration versus intercostal tube drainage.
Fig 6
Fig 6. Meta-analysis of the hospital stay associated with aspiration versus intercostal tube drainage.
See this image and copyright information in PMC

References

    1. Bense L, Eklund G, Wiman LG. Smoking and the increased risk of contracting spontaneous pneumothorax. Chest. 1987;92: 1009–1012 - PubMed
    1. Melton LJ, 3rd, Hepper NG, Offord KP. Incidence of spontaneous pneumothorax in Olmsted County, Minnesota: 1950 to 1974. Am Rev Respir Dis. 1979;120: 1379–1382. doi: 10.1164/arrd.1979.120.6.1379 - DOI - PubMed
    1. Gupta D, Hansell A, Nichols T, Duong T, Ayres JG, Strachan D. Epidemiology of pneumothorax in England. Thorax. 2000;55: 666–671 doi: 10.1136/thorax.55.8.666 - DOI - PMC - PubMed
    1. Schramel FM, Postmus PE, Vanderschueren RG. Current aspects of spontaneous pneumothorax. Eur Respir J. 1997;10: 1372–1379 - PubMed
    1. Chambers A, Scarci M. In patients with first-episode primary spontaneous pneumothorax is video-assisted thoracoscopic surgery superior to tube thoracostomy alone in terms of time to resolution of pneumothorax and incidence of recurrence? Interact Cardiovasc Thorac Surg. 2009;9: 1003–1008. doi: 10.1510/icvts.2009.216473 - DOI - PubMed