BACKGROUND: Spontaneous pneumothorax (SP) is a widespread clinical entity, and methods of managing adult SP remain controversial. The aim of this meta-analysis was to further determine the clinical efficacy and safety of simple aspiration (SA) in comparison to intercostal tube drainage (ITD) during the management of adult SP.
METHODS: EMBASE, Medline and the Cochrane Central Register of Controlled Trials via Ovid SP were searched (to June 2023) to identify randomized controlled trials (RCT) that reported outcomes of interest after comparing SA with ITD for the management of adult SP.
RESULTS: The search strategy yielded 1447 citations, of which 10 RCTs enrolling 1044 subjects were included. Compared with the ITD group, the SA group had a significantly lower the initial success rate of the procedure for the management of SP (OR 0.63, 95% CI [0.47-0.86]; P = 0.004). Moreover, SA was associated with a decreased duration of hospitalization (mean difference-2.05 days, 95% CI [-2.66 - -1.44]; P < 0.001) and a decreased need for operation (P = 0.03). For frequently reported adverse events such as subcutaneous emphysema (P = 0.32), bleeding (P = 0.0.26) and wound infection (P = 0.07), no significant difference between the SA and ITD groups was found. There was no significant difference for other outcomes. Subgroup analysis found that there was no significant difference between SA and ITD in terms of the initial success rate, 1-week success rate or any type of adverse event for PSP patients.
CONCLUSIONS: In the management of adult SP, the use of SA decreased the initial success rate but also decreased the duration of hospitalization and the need for operation compared with ITD. The incidence of adverse events did not differ between the two approaches. The research plan was registered at PROSPERO, and the registration number was CRD42023436770.
| Specialty | Score |
|---|---|
| Emergency Medicine | |
| Respirology/Pulmonology | |
| Hospital Doctor/Hospitalists | |
| Internal Medicine |
Emergency Medicine has been discussing simple aspiration for spontaneous pneumothorax for at least a decade (see https://emergencymedicine.wustl.edu/items/first-time-spontaneous-pneumothorax-management-with-simple-aspiration/ & https://emergencymedicine.wustl.edu/aspiration-versus-chest-tube-placement-for-spontaneous-pneumothorax/), so this is not newsworthy for emergency medicine.
A really useful synthesis of an increasingly robust evidence base. I am sure there is an opportunity to leverage these findings to improve patient care and reduce resource utilization.
Not sure this is impactful enough to change patient care.
Simple aspiration for spontaneous pneumothorax (SP) has never been practiced in any healthcare setting where I have worked. The choice is monitoring a patient with a stable SP, or a chest tube for a "large" SP or unstable patient. Albeit well done, I am not sure this meta-analysis helps me select which patients with SP might be a candidate for simple aspiration.
This meta-analysis finds that for patients with spontaneous pneumothorax, simple aspiration led to lower initial success rates but shorter time in hospital and a lower risk for operative management compared with chest tube placement. The results are heavily influenced by the largest and most recent clinical trial, with which most clinicians are likely familiar.
Another meta-analysis looking at managing spontaneous primary pneumothorax. Although rigorously done, the study does not add new information that will change current practice.
There is an increase in reviews (AI?) with little clinical usefulness.
, McMaster University