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Multicenter Study
. 2020 May:166:105931.
doi: 10.1016/j.rmed.2020.105931. Epub 2020 Mar 16.

Exclusive ambulatory management of spontaneous pneumothorax with pigtail catheters, a prospective multicentric study

Alexandre Salé  1 , Laurent Sohier  2 , Marine Campion  3 , Régis Le Hô  4 , Yann Bazin  5 , Cédric Gangloff  4 , Mallorie Kerjouan  5 , Bertrand Delatour  6 , Emmanuel Oger  7 , Stéphane Jouneau  8
Affiliations
Free article
Multicenter Study

Exclusive ambulatory management of spontaneous pneumothorax with pigtail catheters, a prospective multicentric study

Alexandre Salé et al. Respir Med. 2020 May.
Free article

Abstract

Objective: Spontaneous pneumothorax occurs most frequently in young active patients. Published guidelines do not all agree about its initial management; most patients are hospitalised and treated with chest tube. This prospective multicentric cohort study was designed to assess the potential of ambulatory management.

Methods: We included all consecutive patients with large spontaneous primary (PSP) and secondary pneumothoraces (SSP) presenting at the Lorient, Vitré and Rennes hospitals between December 2013 and July 2016. They were treated with a small-bore pigtail catheter and one-way valve and managed as outpatients following a specific protocol. When this failed, patients were hospitalised on day 4 for suction and surgical pleurodesis was envisaged on day 6. Patients were followed-up for one-year to assess relapse.

Results: Of the 148 patients included (129 PSP, 19 SSP), 122 (82⋅4%) were managed exclusively as outpatient with success in 84⋅5% of PSP and 68⋅4% of SSP patients. There were few complications: 13 vaso-vagal episodes and 3 minor bleedings. The one-year recurrence rates were 33⋅1% for PSP and 52⋅6% for SSP (p = 0⋅114 Hazard Ratio = 0⋅538; IC95% [0⋅249-1⋅161]).

Conclusion: These results are consistent with our previous study and confirm that this exclusive ambulatory management of spontaneous pneumothoraces can be successfully implemented in new centres with a high success rate and few complications.

Keywords: Ambulatory; Chest tube; Drainage; Pneumothorax.

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Conflict of interest statement

Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Dr. Salé reports personal fees and non-financial support from AIRB, Boehringer, Roche, outside the submitted work; Dr. de Latour has nothing to disclose; Dr. Sohier has nothing to disclose; Dr. Campion has nothing to disclose; Dr. Le Ho has nothing to disclose; Dr. Bazin has nothing to disclose; Dr. Gangloff has nothing to disclose; Dr. Kerjouan has nothing to disclose; Dr. Oger has nothing to disclose; Dr. Jouneau reports grants from Rennes University Hospital (COREC 2011 funding), the ‘Association pour les insuffisants respiratories de Bretagne’ (AIRB), the French Ministry of Labour (DIRRECTE), and Novartis Pharma., during the conduct of the study; grants and non-financial support from AIRB, Boehringer, Gilead, GSK, LVL, Roche, Savara/Serendex, personal fees and non-financial support from Actelion, AIRB, Astra Zeneca, BMS, Boehringer, Chiesi, GSK, Mundipharma, Novartis, PfizerRoche, outside the submitted work.

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