Journal Jam 2: Small Bore Chest Tube and Outpatient Management of Pneumothorax

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…..

Outpatient Spontaneous Pneumothorax Management Protocol from Credit Valley Hospital care of Dr. Eric Letovsky & Dr. John Foote

One Algorithm for Spontaneous Pneumothorax Management

Outpatient-Pneumothorax-Algorithm

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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

Fraser J, Maskell, N. Ambulatory treatment in the management of pneumothorax: a systematic review of the literature. BMJ Thorax. 2013;68:664–669. Full pdf
Benton IJ, Benfield GF. Comparison of a large and small-calibre tube drain for managing spontaneous pneumothoraces. Respir Med. 2009 Oct;103(10):1436-40. Full pdf
Damien Contou, et al. Small-bore catheter versus chest tube drainage for pneumothorax. Amer J Emerg Med. Volume 30, Issue 8, October 2012, Pages 1407–1413. Abstract
Hassani B, Foote J, Borgundvaag B. Outpatient management of primary spontaneous pneumothorax in the emergency department of a community hospital using a small-bore catheter and a Heimlich valve. Acad Emerg Med. 2009 Jun;16(6):513-8. Full pdf

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About the Author:

Dr. Anton Helman is an Emergency Physician at North York General in Toronto. He is an Assistant Professor at the University of Toronto, Division of Emergency Medicine and the Education Innovation Lead at the Schwartz-Reisman Emergency Medicine Instititute. He is the founder, editor-in-chief and host of Emergency Medicine Cases.

2 Comments

  1. Paul Jones December 9, 2014 at 5:40 pm - Reply

    Great discussion guys. Found this topic quite interesting. Will have to read more on this topic and see what we do in our shop.

    • Anton Helman December 11, 2014 at 10:01 pm - Reply

      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

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