• Shieh Mei Lai and Augustine Kim Huat Tee.
• Department of Accident and Emergency, Changi General Hospital, 2 Simei Street, Singapore. shieh_mei_lai@cgh.com.sg
• Eur J Emerg Med. 2012 Dec 1;19(6):400-4.

AimTo review the outcomes and safety profile of small-bore (8 Fr) chest drains with a Heimlich valve for the treatment of primary spontaneous pneumothorax.MethodologyA retrospective casenotes review was carried out for pneumothorax cases treated with a small-bore chest drain and connected to a Heimlich valve in the emergency department during a 14-month period from 1 August 2009 to 30 September 2010. Inclusion criteria were primary spontaneous pneumothorax, first episode, unilateral, at least 2-cm rim of air and no or minimal associated pleural effusion. Exclusion criterion was tension pneumothorax. Key outcomes studied were the success rate, as defined by sustained, complete lung re-expansion without the need for alternative intervention (e.g. conventional chest tube or surgery) or admission and complication rates.ResultsA total of 55 patients fulfilled the inclusion criteria and were treated with an 8 Fr chest tube and a Heimlich valve. The study population was predominantly (87.3%) male. The age range was 14-48 years (median 20). The overall success rate (as defined above) was 65.5% [95% confidence interval (CI): 51.4-77.8%]. The rate of surgical pleurodesis was 23.6% (95% CI: 13.2-37%). Complications encountered were tube blockage by haemoserous discharge (1.8%; 95% CI: 0-9.7%) and tube dislodgement (5.5%; 95% CI: 1.1-15.1%).ConclusionOur results suggest that the use of a small-bore chest drain and a Heimlich valve is a safe and efficacious mode of treatment for primary spontaneous pneumothorax, which enables management of the majority of these patients as outpatients.

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