pneumothorax; trauma; ventilation. §ifV§sóxzêGqd^«ÌúcV®8:fP~µnË2nwDYXÐ Öõ§ýõEYR`Yûoõ¬-vÌÓ O©y©¦íyó=RÖÒkA¦ûaWÔÕ8íAèð$cöæÊÔ¬ÀæZf¬û©¢*Ö:+90´ûû:aù Ò@%Îá1Ðû7í ê oc¿É- Eñ*Ájº¯HIzDpÌ2FÊ@hµtúÖM×ôÝã}¶XÁ`i9]ÌmRÕÿI*©%þ&©ÌUi\Ü`eè!Â#¸LE´ø¼Lsóº Û The PSP trial: Brown SGA, Ball EL, Perrin K, et al. The aim of this study was to assess the treatment, complications, and outcomes of traumatic pneumothoraces in patients presenting to a major trauma center. Based on historical literature conservative management of primary spontaneous pneumothorax is best supported by a 1966 cohort study. å¦)zå|iÂk2{J%©¹dûs|c=6uìyæa2ö?¹po{¯÷G°83wÀ©jOK[Íõ9ZC[è´ÂsxäØí*z+qm(\:Öm5LõýNA}©5Ë ázz_ Deep learning detection and quantification of pneumothorax in heterogeneous routine chest computed tomography. This study aimed to evaluate the feasibility of conservative management for primary spontaneous pneumothoraces of any size. Introduction Current management of primary spontaneous pneumothorax (PSP) is variable, with little evidence from randomised controlled trials to guide treatment. Only the presence of a large hemothorax was associated with an increased likelihood of failure of conservative management. This site needs JavaScript to work properly. Inaba K, Lustenberger T, Recinos G, Georgiou C, Velmahos GC, Brown C, Salim A, Demetriades D, Rhee P. J Trauma Acute Care Surg. FOIA In our experience high-frequency oscillatory ventilation provided a conservative management of a significant pneumothorax in preterm newborns hemodynamically stable and requiring mechanical ventilation. Despite this, there is a paucity of literature regarding their optimal management, including 2020 Apr 17;4(1):26. doi: 10.1186/s41747-020-00152-7. How does conservative and interventional management of collapsed lung compare? Conservative management resulted in a lower risk of serious adverse events or pneumothorax recurrence than interventional management. Kirkpatrick AW, Rizoli S, Ouellet JF, Roberts DJ, Sirois M, Ball CG, Xiao ZJ, Tiruta C, Meade M, Trottier V, Zhu G, Chagnon F, Tien H; Canadian Trauma Trials Collaborative and the Research Committee of the Trauma Association of Canada. Conservative versus interventional management for primary spontaneous pneumothorax in adults. Conservative versus Interventional Treatment for Spontaneous Pneumothorax.The New England journal of medicine. Epub 2018 Apr 19. Studies have focused on whether there is a role for conservative management for occult pneumothoraces that are not initially visible on chest radiography.6, 12 The resultant positive findings, including in patients receiving PPV, have been incorporated into clinical guidelines. according to clinical management. Primary spontaneous pneumothorax (PSP) is defined as a collapsed lung with air in the pleural cavity that occurs in the absence of … Limitations of the study included lack of blindness of the outcome assessors that could have introduced some bias. Demographics, mechanism of injury, injury severity score (ISS), management, and outcomes were analyzed. Importantly, this also applies to patients requiring PPV, with no significant increased risk of failure of expectant management. Some sort of intervention is usually advised for the bigger pneumothoraces and written guidelines, often extrapolated from adult evidence, recommend drainage. BJA Educ. Traumatic pneumothoraces are a common consequence of major trauma. Conservative management of spontaneous pneumothorax was noninferior to interventional management in patients with moderate-to-large primary lung collapse at … Main results. Clipboard, Search History, and several other advanced features are temporarily unavailable. Semin Respir Crit Care Med. J Accid Emerg Med. Prevention and treatment information (HHS). Unable to load your collection due to an error, Unable to load your delegates due to an error. Background: Whether conservative management is an acceptable alternative to interventional management for uncomplicated, moderate-to-large primary spontaneous pneumothorax is … ", An alternative approach, conservative management, may be associated with lower risk and a shorter hospital stay, but there is a lack of directive data … December 2014. doi: 10.1002/14651858.cd010565.pub2 1996 May;13(3):173-4. doi: 10.1136/emj.13.3.173. Published by Elsevier Inc. All rights reserved. Keywords: The occult pneumothorax: what have we learned? The aim of this study was to assess the treatment, complications, and outcomes of traumatic pneumothoraces in patients presenting to a major trauma center. A prospective analysis of 28-32 versus 36-40 French chest tube size in trauma. Conclusions: Although the primary outcome was not statistically robust to conservative assumptions about missing data, the trial provides modest evidence that conservative management of primary spontaneous pneumothorax was noninferior to interventional management, with a lower risk of serious adverse events. Please enable it to take advantage of the complete set of features! Results: There was a statistically significant difference between conservative and non-conservative types of management in the incidence of complications after 1 week follow up (p = 0.001). The question of conservative management of occult pneumothorax was also briefly mentioned in a larger review on blunt chest trauma in 2015. Conservative management consists of observing the patient, oxygen therapy, and analgesia . National Library of Medicine 8600 Rockville Pike Chest radiography follow-up at 8weeks was missing for 23 patients in the intervention group and for 37 in the conservative management group. 2013 Mar;74(3):747-54; discussion 754-5. doi: 10.1097/TA.0b013e3182827158. Occult pneumothoraces in critical care: a prospective multicenter randomized controlled trial of pleural drainage for mechanically ventilated trauma patients with occult pneumothoraces. Two hundred fifty-two of 277 patients in this cohort (90%) did not require subsequent chest tube insertion, including the majority of patients (56 of 62 [90%]) who were receiving positive pressure ventilation (PPV) on admission. Guidelines emphasise intervention in many patients, which involves chest drain insertion, hospital admission and occasionally surgery. Early Autologous Blood-Patch Pleurodesis versus Conservative Management for Treatment of Secondary Spontaneous Pneumothorax Thorac Cardiovasc Surg. Conclusions: Conclusion: The majority of asymptomatic small pneumothorax patients following a stab injury can be … J Trauma Acute Care Surg. Despite this, there is a paucity of literature regarding their optimal management, including the role of conservative treatment. Only the presence of a large hemothorax was associated with an increased likelihood of failure of conservative management. The imaging of pneumothorax has undergone a major change due to the advent of PACS technology, and the implications of this are now described. 2012 Feb;72(2):422-7. doi: 10.1097/TA.0b013e3182452444. Of the 602 traumatic pneumothoraces, 277 of 602 (46%) were initially treated conservatively. Clinically stable patients with small pneumothoraces can be treated with conservative management, and they should stay in the emergency room with a control chest radiograph to perceive the resolution of pneumothorax. Accessibility Results: Röhrich S, Schlegl T, Bardach C, Prosch H, Langs G. Eur Radiol Exp. 5.1 Conservative management. Traumatic pneumothorax: is a chest drain always necessary? Background: Patients were assigned to either interventional management of the pneumothorax with a small-bore (≤12 French) chest tube or conservative management with a 4-hour observation and no intervention; the noninferiority margin was set at 9%. Conservative management of relatively small pneumothorax in the medical and trauma literature has been studied and is practiced clinically. Copyright © 2017 American College of Chest Physicians. Study protocol for a randomised controlled trial of invasive versus conservative management of primary spontaneous pneumothorax. BACKGROUND Whether conservative management is an acceptable alternative to interventional management for uncomplicated, moderate-to-large primary spontaneous pneumothorax is unknown. }Û"(òà¡ Äøàú~iLq£ÈH=èzà¨Ú¶è±Ã. Prospective, Randomised control, non-inferiority trial These factors were decided in an a priori Both the Article1 and accompanying Comment2 show that less is more in the treatment of spontaneous pneumothorax. The hazard ratio (HR) for failure of conservative management showed no difference between the ventilated and nonventilated patients (HR, 1.1; P = .84). Spontaneous pneumothorax is a generally benign, self-limiting condition where conservative management should be considered. Symptoms typically include sudden onset of sharp, one-sided chest pain and shortness of breath. Conclusions In the largest observational study of traumatic pneumothoraces published to date, > 90% of patients whose pneumothorax was managed conservatively never required subsequent tube drainage. Cochrane Database of Systematic Reviews . Six hundred two patients were included during the study period. Conservative treatment has been proposed, but no studies comparing conservative with invasive management have been carried out where pneumothorax size has been numerically quantified. In the intervention group, 10 patients (6.5%) declined an intervention; in the conservative management group, 25 patients (15.4%) underwent interventions to manage the pneumothorax for reasons pre-specified in the protocol. In a minority of cases, a one-way valve is formed by an area of damaged tissue, and the amount of air in the space between chest wall and lungs increases; this is called a tension pneumothorax. 2020; 382(5):405-415. Epub 2011 Jan 6. Careers. Conservative Management in Traumatic Pneumothoraces Q1 An Observational Study Q16 Steven P. Walker, MBChB; Shaney L. Barratt, BMBS, PhD; Julian Thompson, MD(Res); Q2 Q3 and Nick A. Maskell, DM, FCCP BACKGROUND: Traumatic pneumothoraces are a common consequence of major trauma. Study protocol for a randomised controlled trial of invasive versus conservative management of primary spontaneous pneumothorax Simon G A Brown,1,2 Emma L Ball,1,3 Kyle Perrin,4,5 Catherine A Read,1 Stephen E Asha,6,7 Richard Beasley,4,5 Diana Egerton-Warburton,8,9 Peter G Jones,10 Gerben Keijzers,11,12,13 Frances B Kinnear,14,15 BenCHKwan,16,17 Y C Gary Lee,18,19 Julian A … Traumatic pneumothoraces are a common consequence of major trauma. Whether conservative management is an acceptable alternative to interventional management for uncomplicated, moderate-to-large primary spontaneous pneumothorax is unknown. Observational data suggests conservative management may be a viable option and there is a clear need for robust trial data to support this; Design. determine which factors (age, size of pneumothorax, ISS, presence of rib fractures, clinical conditions [respiratory, hemodynamic, GCS score], presence of hemothorax, bilateral vs unilateral pneumothorax, and use of PPV) were independently predictive of failure of conservative management. We congratulate Rob Hallifax and colleagues1 on their study of the management of moderate-to-large primary spontaneous pneumothorax. METHODS In this open-label, multicenter, noninferiority trial, we recruited patients 14 to … Does size matter? 2019 Apr;67(3):222-226. doi: 10.1055/s-0038-1642028. Grant ID: EMSS-12-190-KINNEAR-PSPS Lay Summary. When faced with a spontaneous simple pneumothorax, in a previously well child the Archivist would probably leave the smallest of air leaks alone (in a child with no symptoms) and follow-up conservatively. COVID-19 is an emerging, rapidly evolving situation. In the largest observational study of traumatic pneumothoraces published to date, > 90% of patients whose pneumothorax was managed conservatively never required subsequent tube drainage. Anaesthetic and surgical management of rib fractures. When only including patients who had However, the trend towards more conservative management is maintained, with observation for many patients with PSP, aspiration for the remainder, and small-bore chest drains for persistent air leaks. this period conservative management was largely abandoned in favour of rapid lung re-expansion.13 However, it has been proposed that rapidly re-expanding the collapsed lung adversely affects stopping the air leak, which is the principal cause of the pneumothorax.14 Lately, therefore, conservative management has been sug- Iä +ñ÷É-´Ä¢. Would you like email updates of new search results? Epub 2020 Jul 23. Despite this, there is a paucity of literature regarding their optimal management, including the role of conservative treatment. 2010 Dec;31(6):769-80. doi: 10.1055/s-0030-1269837. Of 316 patients, 154 patients were randomised to the intervention group and 162 to the conservative management group. However, there is evidence that conservative management may be effective and safe, and … Brown SG , Ball EL , Perrin K , Read CA , Asha SE , Beasley R , Egerton-Warburton D , Jones PG , Keijzers G , Kinnear FB , Kwan BC , Lee YC , Smith JA , Summers QA , Simpson G , PSP Study Group This approach allowed us to avoid the increasing of air leak and the insertion of chest tube drainage and all the subsequent associated risks. The prospectively collected Trauma Audit and Research Network (TARN) database was used to identify all patients presenting with traumatic pneumothoraces to a UK major trauma center from April 2012 to December 2016. Only the presence of a large hemothorax was associated with an increased likelihood of failure of conservative management. 2020 Oct;20(10):332-340. doi: 10.1016/j.bjae.2020.06.001. conservative management group, 25 patients (15.4%) underwent interventions to manage the pneumothorax for reasons pre-specified in the protocol. Privacy, Help Conclusions: In the largest observational study of traumatic pneumothoraces published to date, > 90% of patients whose pneumothorax was managed conservatively never required subsequent tube drainage. Methods: If intervention is needed, medical thoracoscopy might … We would argue that even less could be even more. These data support a role for conservative management in traumatic pneumothoraces. In group A were 88 patients who were managed successfully on an entirely conservative basis and without admission to hospital, a practice originally sug-gested byexperience with artificial pneumothorax. Mean age was 48 years (SD, 22 years), and 73% were men. Mean ISS was 26 and inpatient mortality was 9%. PMID: 31995686 [full text] A pneumothorax is an abnormal collection of air in the pleural space between the lung and the chest wall. Bethesda, MD 20894, Copyright
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