Outpatient management of primary spontaneous pneumothorax using small-bore catheter: A prospective study

The various guidelines published about the management of primary spontaneous pneumothorax (PSP), have raised up discrepancies regarding indications and methods of air-removal. We aimed to assess the feasibility of a single system small-bore drain based management. Primary end-point was 1-week success rate, secondary ones were the part of full outpatient management, the 1-year recurrence rate, the length of hospitalization stay, the cost and the side-effects. All patients aged ≥ 16 years with 1st episode of PSP, were managed in the emergency room (ER) by observation alone or insertion of an 8.5 F “pigtail” drain, according to PSP volume and clinical tolerance. The drain was connected to a one-way Heimlich valve. Patients were re-assessed at the 4th hour for potential admission or discharge. Patients still having air leak at day-4 were referred for video-assisted thoracoscopy (VATS). On the 60 patients recruited, 80% underwent drainage and 60% were discharged after 4 hours. Success rate was 83% at day-7, the 17% left underwent a VATS. Fifty per cent of the patients benefited from strict outpatient management and 2 procedure-related complications occurred. The mean length of hospitalization was 2.3±3.1 days, the 1-year recurrence rate was 17%. The financial gain of this PSP management was 1,791 to 3,940 Euros/patient/episode, compared with manual aspiration (MA) or conventional chest tube drainage (CTD). This one-system management offers good efficacy, safety, comfort and aesthetics; it is time and cost-effective. Our results suggest its use in a larger population, but a randomised controlled study comparing it with MA and/or CTD is needed for validation.