It makes sense that the treatment of primary spnontaneous pneumothorax would lend itself well to outpatient management, since patients are usually young and otherwise healthy, and the mortality and morbidity from these air leaks are really very low. Most patients would rather be managed as an outpatient rather than admitted to hospital and sending these patients home would probably end up saving the system resources and money. In this month’s Journal Jam Podcast on small bore chest tube and outpatient management of pneumothorax, the highlighted article that Anton Helman and Teresa Chan discuss is Voison et al. “Ambulatory Management of Large Spontaneous Pneumothorax With Pigtail Catheters.” We hear from Michelle Lin, Seth Trueger, Heather Murray and the lead author himself, Stephan Jouneau. Questions posed include: In what ways is the use of small bore catheters with Heimlich valves for spontaneous pneumothorax better than needle aspiration? Is it necessary to repeat a CXR after placement of the catheter? Who should follow up these patients after they are discharged from the hospital? How can we minimize kinking and dislodgement of the catheter? and many more…..
Podcast: Play in new window | Download (Duration: 34:29 — 31.6MB)
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Podcast production, editing and sound design by Anton Helman.
Blog post by Anton Helman December, 2014.
Cite this podcast as: Helman, A, Chan, T, Jouneau, S, Lin, M, Trueger, S, Murray, H. Small Bore Chest Tube and Outpatient Management of Pneumothorax. Emergency Medicine Cases. December, 2014. https://emergencymedicinecases.com/ournal-jam-2-small-bore-chest-tube-pneumothorax/. Accessed [date].
Outpatient Spontaneous Pneumothorax Management Protocol from Credit Valley Hospital care of Dr. Eric Letovsky & Dr. John Foote
One Algorithm for Spontaneous Pneumothorax Management
Video of Placement of Pigtail Cathether
Link to Step by step procedure of small bore chest tube insertion
Link to Literature review on use of small bore chest tubes in traumatic pneumothorax
Link to Academic Life in EM Blog and Google Hangout with Michelle Lin, Seth Treuger, Heather Murray and the lead author Dr. Jouneau
Main Reference for this Journal Jam Podast
Voisin F, Sohier L, Rochas Y, Kerjouan M, Ricordel C, Belleguic C, Desrues B, Jouneau S. Ambulatory management of large spontaneous pneumothorax with pigtail catheters. Ann Emerg Med. 2014 Sep;64(3):222-8. Full pdf
Other Key References
Great discussion guys. Found this topic quite interesting. Will have to read more on this topic and see what we do in our shop.
Thanks of the cudos Paul. We have had excellent doctor and patient satisfaction with outpatient management of spontaneous pneumothorax. The protocol in the blogpost might be a good starting point for you shop if they are considering this. As you can see, the protocol is about 15 years old, and hasn’t changed since then. Would be happy to provide any other info you might require. Anton