Comparison of large‐ and small‐bore intercostal catheters in the management of spontaneous pneumothorax

Abstract

Background: Spontaneous pneumothoraces (SP) are a common cause of presentation to emergency departments and subsequent hospitalization. In recent years there has been an increasing trend towards the use of small‐bore pleural catheters (PC) rather than conventional large‐bore intercostal catheters (ICC) in their initial management. Aims: To compare the effectiveness and complication rate of ICC and PC in the treatment of SP. Methods: A retrospective chart audit was conducted of 67 cases of SP admitted to the Royal Prince Alfred ­Hospital, Sydney, Australia, between 1 July 1997 and 30 June 2000. Demographic data were recorded, ­including: (i) patient age, (ii) smoking status, (iii) pneumothorax size, (iv) pneumothorax type and (v) aetiology. Outcome data relating to length of hos­pital stay (LOS) and treatment failure rates and comp­lications of treatment devices were also recorded. Results: Successful pneumothorax resolution was achieved (P = 0.72) in 20 of the 31 (65%) patients initially treated with a ICC, and in 26 of the 36 (72%) patients treated with a PC. The mean LOS in the ICC and PC group was 7 days and 5 days, respectively (P = 0.11). The complication rates in the PC and ICC group were 25% and 10%, respectively (P = 0.13), and the recurrence rates for each group were 17% and 6% (P = 0.20), respectively. However, the combined rate of complications and pneumothorax recurrence within 2 months was 42% in those initially treated with PC, compared with 16% in those treated with ICC (P = 0.04). Conclusions: PC were as effective as ICC in treating SP in terms of initial pneumothorax resolution and LOS. There were trends towards higher complication and recurrence rates in those treated with PC, but individ­ually these results did not reach statistical significance. However, the combined rate of complications and pneumo­thorax recurrence was significantly higher in those patients treated with the PC than in those treated with ICC. (Intern Med J 2003; 33: 495−499)