Needle aspiration better than chest drain for spontaneous pneumothorax
Date First Published:
March 1, 2000
Last Updated:
April 11, 2001
Report by:
Ashes Mukerjee, Research Fellow (Manchester Royal Infirmary)
Search checked by:
Kevin Mackway-Jones, Manchester Royal Infirmary
Three-Part Question:
In [a young patient with a spontaneous pneumothorax without tension] is [needle aspiration or chest drainage] better at [reinflating the lung, reducing hospital stay and preventing recurrence]?
Clinical Scenario:
A 25 year old patient with no history of respiratory disease attends the Emergency Department with acute onset of shortness of breath. A chest x-ray reveals a left-sided pneumothorax of approximately 50% the volume of the left lung; there is no tension. You wonder whether needle aspiration or chest drain insertion is the treatment of choice.
Search Strategy:
Medline 1966-03/99 using the OVID interface.
Search Details:
({exp pneumothorax OR pneumothora$} AND {exp aspiration OR aspiration.mp OR thoracocentesis.mp} AND {exp chest tubes OR drainage OR exp thoracostomy OR chest drain$.mp}) LIMIT to human and english language.
Outcome:
83 papers found of which 81 were irrelevant.
Relevant Paper(s):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| Simple aspiration versus intercostal tube drainage for spontaneous pneumothorax in patients with normal lungs. Harvey J, Prescott RJ. 1995 UK | 73 patients with spontaneous pneumothorax. Needle aspiration (35) vs intercostal drain (38) |
PRCT | Success rate | 80% vs 100% | Small numbers. Large differences in groups at baseline in terms of size of pneumothorax (34% vs 58% complete collapse) |
| Pain score during procedure | No significant difference | ||||
| Hospital stay | 3.2 vs 5.3 days (P = 0.005) | ||||
| Recurrence rate | No significant difference | ||||
| Spontaneous pneumothorax. Comparison of thoracic drainage vs immediate or delayed needle aspiration. Andrivet P, Djedaini K, Teboul JL et al. 1995 France | 61 patients with first or second episode of spontaneous pneumothorax. Needle aspiration (33) vs thoracic drainage (28) |
RCT | Success rate | 61% vs 93% (P = 0.01) | Small numbers Hospital stay prolonged in needle aspiration group as procedure not carried out for 72 h in most patients. |
| Hospital stay | No significant difference | ||||
| Recurrence rate by 3 months | No significant difference |
Author Commentary:
In these flawed, small studies needle aspiration is shown to be useful in some cases. However the failure rate is high and aspiration cannot therefore be thought of as a single complete treatment for this condition. Further studies are required to confirm the decrease in length of stay in the aspiration group.
Bottom Line:
Needle aspiration may be carried out as the first treatment of spontaneuos pneumthoraces without tension. Patients must then be observed as subsequent intercostal drainage may be necessary.
References:
- Harvey J, Prescott RJ.. Simple aspiration versus intercostal tube drainage for spontaneous pneumothorax in patients with normal lungs.
- Andrivet P, Djedaini K, Teboul JL et al.. Spontaneous pneumothorax. Comparison of thoracic drainage vs immediate or delayed needle aspiration.