Spontaneous pneumothorax (SP) can be a life-threatening condition. It can be primary and caused by unknown reason, or secondary from acute or chronic lung diseases. It was estimated that the SP affected over 20,000 patients and accounted $130 million health-care costs in the United States. The primary management of SP is to remove air from the pleural space. The recommendations of SP management differ across guidelines. Though the trend tends to suggest the use of less invasive small catheters, applying a large chest tube is still common. To validate drainage methods for SP, we compared the effectiveness of a small-bore pigtail catheter with the traditional chest tube in the management of SP.
A search of studies comparing the effect of a small-bore pigtail catheter and a traditional chest tube for SP management was conducted using three Chinese databases (CEPS, the Chinese Thesis/Dissertation database, and the Chinese Journal database) and four English databases (CINAHL, Medline, PubMed, and the Cochrane Central Register of Controlled Trials). The search was up to April, 2016. Evaluations of study quality were conducted by the 2011 Oxford Centre for Evidence-Based Medicine-Levels of Evidence and the Cochrane Collaboration’s tool for assessing risk of bias. Meta-analyses were performed by the random effect model. Pooled effects of drainage failure and length of hospitalization were calculated to present the effectiveness of tubing methods.
Eleven studies involving 783 subjects were identified from 110 citations. Among included studies, only three studies are randomized controlled trials. All studies were unclear or high in risks of random sequence generation, allocation concealment, and blinding of participants and personnel. No difference in the risk of drainage failure was found between the pigtail method and the chest tube method (OR=.67, 95%CI=.41-1.09, p=.10). Among the secondary SP subjects, the length of hospital stay did not differ between two methods as well (OR=-.3, 95% CI=-.68 - -.08, p=.12).
Findings of this study support the use of small-bore pigtail catheters to manage SP. The application of small-bore pigtail catheters is suggested to promote patient compliance and comfort.