D Weissberg1, Y Refaely. 1. Department of Thoracic Surgery, Tel Aviv University Sackler School of Medicine, Tel Aviv, Israel.
Abstract
OBJECTIVE: To study the outcome of pneumothorax managed in a university-affiliated metropolitan medical center. DESIGN: A retrospective review. SETTING: Busy metropolitan medical center. PATIENTS AND METHODS: Records of 1,199 patients with pneumothorax were reviewed and analyzed. RESULTS: Primary spontaneous pneumothorax occurred in 218 patients, secondary spontaneous pneumothorax occurred in 505, traumatic in 403, and iatrogenic in 73. Ninety-six patients with small pneumothorax (8%) were managed by observation, and 1,103 patients (92%) were managed by tube thoracostomy. Drainage of the pleural cavity was continued for 1 to 7 days in 893 patients (81%), 8 to 10 days in 176 patients (16%), and > 10 days in 34 patients (3%). Drainage for > 10 days was classified as persistent pneumothorax. In these 34 patients and in 132 others with a second ipsilateral recurrence (a total of 166 patients), direct pleuroscopy was performed. The pleuroscopy findings and further management are outlined in the algorithm. CONCLUSIONS: Pneumothorax is a common condition affecting all age groups. If the volume of the pneumothorax is > 20% of the pleural space, pleural drainage is indicated. For management of persistent or recurrent pneumothorax, the use of pleuroscopy (direct or video-assisted) is of great value and should be part of routine management.
OBJECTIVE: To study the outcome of pneumothorax managed in a university-affiliated metropolitan medical center. DESIGN: A retrospective review. SETTING: Busy metropolitan medical center. PATIENTS AND METHODS: Records of 1,199 patients with pneumothorax were reviewed and analyzed. RESULTS: Primary spontaneous pneumothorax occurred in 218 patients, secondary spontaneous pneumothorax occurred in 505, traumatic in 403, and iatrogenic in 73. Ninety-six patients with small pneumothorax (8%) were managed by observation, and 1,103 patients (92%) were managed by tube thoracostomy. Drainage of the pleural cavity was continued for 1 to 7 days in 893 patients (81%), 8 to 10 days in 176 patients (16%), and > 10 days in 34 patients (3%). Drainage for > 10 days was classified as persistent pneumothorax. In these 34 patients and in 132 others with a second ipsilateral recurrence (a total of 166 patients), direct pleuroscopy was performed. The pleuroscopy findings and further management are outlined in the algorithm. CONCLUSIONS: Pneumothorax is a common condition affecting all age groups. If the volume of the pneumothorax is > 20% of the pleural space, pleural drainage is indicated. For management of persistent or recurrent pneumothorax, the use of pleuroscopy (direct or video-assisted) is of great value and should be part of routine management.
Authors: Mehmet Ozdogan; Ahmet Gurer; Ali Kaan Gokakin; Selma Gogkus; Ismail Gomceli; Raci Aydin Journal: Intensive Care Med Date: 2004-09-15 Impact factor: 17.440