Emergency Medical Minute16 Aug 2021

Podcast 704: Treatment of Pneumothorax

Contributor: Adam Barkin, MD

Educational Pearls:

Multi-center open-label non-inferiority trial looked at treatment of pneumothorax with a small-bore chest tube versus conservative management with exceptional follow up
316 patients ages 14-50 with moderate to large pneumothorax (>32% measured on CXR) were randomized into one of the two treatment arms
15% of the conservative group required further intervention as determined by prespecified protocols
94.4% of the intervention group had resolution at 8 weeks, whereas 98.5% of the conservative group had resolution at 8 weeks
- These data were affected by poor follow up
CXR resolution average of 16 days in the intervention group and 30 days in the conservative group
Symptom resolution was similar between the two groups (median 15 days vs. 14 days)
Recurrence at 12 months was 17% in interventional group vs 8% in conservative group
41 adverse events in intervention group and 13 adverse events in conservative group

References

Brown SGA, Ball EL, Perrin K, et al. Conservative versus Interventional Treatment for Spontaneous Pneumothorax. N Engl J Med. 2020;382(5):405-415. doi:10.1056/NEJMoa1910775

Franzen, D. (2019, November). Pneumothorax. Society of Academic Emergency Medicine. https://www.saem.org/about-saem/academies-interest-groups-affiliates2/cdem/for-students/online-education/m4-curriculum/group-m4-respiratory/pneumothorax.

Summarized by John Spartz, MS4 | Edited by Erik Verzemnieks, MD

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