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Outpatient Management of Primary Spontaneous Pneumothorax in the Emergency Department of a Community Hospital Using a Small‐bore Catheter and a Heimlich Valve
Author(s) -
Hassani Behzad,
Foote John,
Borgundvaag Bjug
Publication year - 2009
Publication title -
academic emergency medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.221
H-Index - 124
eISSN - 1553-2712
pISSN - 1069-6563
DOI - 10.1111/j.1553-2712.2009.00402.x
Subject(s) - medicine , emergency department , pneumothorax , confidence interval , catheter , clinical endpoint , retrospective cohort study , surgery , outpatient clinic , medical record , emergency medicine , randomized controlled trial , psychiatry
Objectives: The objective was to assess the effectiveness of a small‐bore catheter (8F) connected to a one‐way Heimlich valve in the emergency department (ED)‐based outpatient management of primary spontaneous pneumothorax (PSP). Methods: The authors conducted a structured chart audit in a retrospective case series of patients with PSP who were treated with a small‐bore (8F) catheter and a Heimlich valve who were seen in the ED of a community hospital between April 2000 and March 2005. To be eligible, patients had to be available for a telephone interview. Main outcomes were success of treatment (sustained, complete lung reexpansion), admission, and surgical intervention rates. Secondary outcomes included number of chest x‐rays (CXRs), number of visits to the ED, treatment duration, complications, and recurrence rates. Results: The authors identified 62 discrete episodes of PSP in 50 patients, with a mean (±standard deviation [SD]) age of 25.5 ± 10.5 years (range = 14–53 years). In 50 of 62 episodes (81%, 95% confidence interval [CI] = 70.8% to 90.5%), patients were discharged directly from the ED. Patients were admitted to the hospital at some point for treatment in 27/62 episodes (43.5%, 95% CI = 31.2% to 55.9%). Surgery was performed for acute treatment failure in 17 episodes. Ultimately, 19 patients, who accounted for 21 of 62 episodes (33.9%, 95% CI = 22.1% to 45.6%), had surgery at some point in the study. Mean (±SD) time to admission for those patients initially discharged from the ED was 2.9 (±2.01) days (95% CI = 1.9 to 3.8 days). There were no serious complications from treatment; the minor complication rate (misplacement or dislodging of the chest tube) was 22.6% (95% CI = 12.2% to 33.0%). No association was found between the size of pneumothorax and treatment failure. Conclusions: This study suggests that the initial management of PSP with a small‐bore catheter and Heimlich valve can easily be performed by emergency physicians in the community hospital setting and appears safe. A larger study systematically comparing this approach with alternative therapies is needed.