Safety and efficacy of vacuum bottle plus catheter for drainage of iatrogenic pneumothorax

Abstract

Background: Iatrogenic pneumothorax is common after thoracic procedures. For patients with pneumothorax larger than 15%, simple aspiration is suggested. Although vacuum bottle plus non-tunneled catheter drainage has been performed in many institutions, its safety and efficacy remain to be assessed.

Methods: Through this prospective cohort study (NCT03724721), we evaluated the safety and efficacy of vacuum bottle plus non-tunneled catheter drainage. Patients older than 20 years old who developed post-procedural pneumothorax were enrolled. A non-tunneled catheter was placed at the intersection of the midclavicular line and the second intercostal space. A 3-way stopcock, a drainage set, and a digital pressure gauge were connected. The stopcock was manipulated to connect the pleural space to the pressure gauge for measurement of end-expiration intrapleural pressure or to the vacuum bottle for air drainage. The rate of successful drainage, the end-expiration intrapleural pressure before, during, and after the procedure and the duration of hospitalization were recorded.

Results: From August 2018 to February 2020, 21 patients underwent vacuum bottle plus catheter drainage (intervention group) and 31 patients received conservative treatment (control group). The end-expiration intrapleural pressure of all patients remained less than - 20 cmH2O during drainage. No procedure related complication was observed. Large pneumothorax (≥ 15%) was associated with higher risk of persistent air leak (Odds ratio 12, 95% CI 1.2-569.7). Vacuum bottle assisted air drainage yielded shorter event-free duration than that of conservative treatment (2 days vs 5 days [interquartile range 1-4 days vs 3-7 days], p < .05). Vacuum bottle assisted air drainage also help identifying patients with persistent pneumothorax and necessitate the subsequent management. The event-free duration of persistent air leak in the intervention group was also comparable with that of conservative treatment (5 days vs 5 days [interquartile range 5-8 days vs 3-7 days], p = .45).

Conclusions: Vacuum bottle plus catheter drainage of iatrogenic pneumothorax is a safe and efficient procedure. It may be considered as an alternative management of stable post-procedural pneumothorax with size larger than 15%. Trial registration The study protocol was approved by the Research Ethics Committee of National Taiwan University Hospital (No. 201805105DINA) on 6th August, 2018. The first participant was enrolled on 23rd August, 2018 after Research Ethics Committee approval. This clinical trial complete registration at U.S. National Library of Medicine clinicaltrials.gov with identifier NCT03724721 and URL: https://ichgcp.net/clinical-trials-registry/NCT03724721 on 30th October, 2018.

Keywords: Drainage of pneumothorax; Iatrogenic pneumothorax; Intrapleural pressure; Vacuum bottle.

Conflict of interest statement

The authors declare that they have no competing interests.

© 2022. The Author(s).

Figures

Fig. 1

A schematic diagram of how vacuum bottle plus non-tunneled catheter air drainage and end-expiration intrapleural pressure were measured

Fig. 2

A Initial treatment algorithm of iatrogenic pneumothorax. Needle aspiration: vacuum bottle plus catheter drainage. *Decision was made by shared decision making. Conservative treatment: oxygenation. B Flow chart of subject recruitment process for this study. *Transient air leak denotes no further enlargement of pneumothorax after vacuum bottle assisted aspiration or oxygenation only; Persistent air leak represents that pneumothorax enlarged either after initial management or need further intervention

Fig. 3

Box plots for comparison of time to event-free duration between the intervention group and control group. Median (interquartile range); n = patient number. *Patients with comparable size of pneumothorax (≥ 10%) with the intervention group were included for comparison