Journal of Rawalpindi Medical College (Dec 2017)
Effectiveness of Needle Aspiration in the Management of Spontaneous Pneumothorax
Abstract
Background: To determine the efficacy of needle aspiration in the management of spontaneous pneumothorax (SP), and to compare its efficacy in primary and secondary spontaneous pneumothorax . Methods: In this prospective observational study all adult patients of spontaneous pneuthorax(SP). Patients with tension pneumothorax, critically ill, hydro- pneumothorax and patients with recurrent pneumothorax were excluded. The investigations carried out included a variable combination of radiological (e.g. Chest CT scan), microbiological (sputum gram’s stain, culture and AFB smears) and serological (e.g. HIV serology) tests. Patients were classified as having primary spontaneous pneuomotharax (PSP) or Secondary spontaneous pneomothorax ( SSP) if routine clinical, radiological and relevant additional investigations fail to prove a disease process that could potentially explain the occurrence of pneumothorax. All the patients were managed with simple needle aspiration and high flow oxygen as the initial treatment modality irrespective of the class. Air was manually aspirated until resistance was felt or aspirated volume reached 2.5L followed with a CXR. The procedure was deemed successful when lung expansion was complete or a very small rim of air was present along with symptomatic improvement. If during manual aspiration 3000 ml or more had to be aspirated without signs of re-expansion, or if second manual attempt was unsuccessful, a subsequent tube thoracostomy was performed. Needle aspiration was carried out after giving local anesthesia by 2% lignocaine at 2nd intercostal space in mid clavicular line on the diseased side of chest. Patients were categorized into two groups , i.e., Group A = Successful on needle aspiration and Group B = Unsuccessful on needle aspiration. Outcome parameters were compared between PSP and SSP. Results: Of the study population (n=577), 64.4% were male . PSP was seen in 29.50% and 70.50% had SSP. The underlying cause of SSP was pulmonary tuberculosis in 44.72% , obstructive respiratory diseases in 32.18% and interstitial lung diseases in 13.75% . Needle aspiration was successful in 60.65%. Conclusion: Percutaneous needle aspiration can be used as first line procedure in managing SP. However, its effectiveness varies in different clinical settings. It could be the procedure of choice in managing PSP but its effectiveness in SSP is debatable.
