• Am J Emerg Med · Oct 2012

    Comparative Study

    Small-bore catheter versus chest tube drainage for pneumothorax.

    • Damien Contou, Keyvan Razazi, Sandrine Katsahian, Bernard Maitre, Armand Mekontso-Dessap, Christian Brun-Buisson, and Arnaud W Thille.
    • Medical Intensive Care Unit, AP-HP, Henri Mondor Hospital, Créteil, France. contou@club.fr
    • Am J Emerg Med. 2012 Oct 1;30(8):1407-13.

    Study ObjectiveThe aim of the study was to compare the effectiveness of drainage via a single-lumen (5F catheter) central venous catheter (CVC) to a conventional (14-20 F catheter) chest tube (CT) for the management of pneumothoraces, including primary spontaneous pneumothorax (PSP), secondary spontaneous pneumothorax (SSP), and traumatic and iatrogenic pneumothoraces.PatientsAll consecutive patients admitted to the intermediate intensive care unit of a university hospital for pneumothorax were retrospectively screened over an 8-year period. Patients were preferentially treated using CT from 2003 to 2007 and using CVC from 2008 to 2010. Drainage failure was defined as the need for a second drainage procedure or for surgery.ResultsOf 212 patients included, 117 (55%) had PSP, 28 (13%) had SSP associated with chronic obstructive pulmonary disease, 19 (9%) had traumatic pneumothorax, and 48 (23%) had iatrogenic pneumothorax. The failure rate was 23% in PSP, 36% in SSP, 16% in traumatic pneumothorax, and only 2% in iatrogenic pneumothorax. After adjustment, iatrogenic pneumothorax was the only factor that had an influence on drainage failure. The failure rate was similar between the 112 patients treated using CVC and the 100 patients treated using CT (18% vs 21%, P = .60). However, the durations of drainage (3.3 ± 1.9 vs 4.6 ± 2.6 days, P < .01) and of hospital stay were significantly shorter in patients treated using CVC as compared with CT.ConclusionOur findings suggest that drainage via a catheter or via a CT is similarly effective in the management of pneumothorax. We recommend considering drainage via a small-bore catheter as a first-line treatment in patients with pneumothorax, whatever its cause.Copyright © 2012 Elsevier Inc. All rights reserved.

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