Study of pigtail catheter and chest tube in management of secondary spontaneous pneumothorax

Abstract

Background: The initial management for a large and symptomatic secondary spontaneous (SSP) pneumothorax is to remove the air from the pleural space, but recommended methods varied across guidelines, from a large bored chest tube toward less invasive management with the use of smaller catheters. So the aim of this study is to elucidate the effectiveness, safety and tolerability of small bore catheter in draining (SSP). Patients and methods: This study is a prospective randomized controlled trial (RCT) which was carried out at Chest Department, Zagazig University Hospitals and included 22 patients with SSP. The cases were enrolled into the study according to the following criteria: first episode of SSP, large size pneumothorax, SSP with circulatory and respiratory distress (tension pneumothorax) irrespective of the size of pneumothorax. The patients were randomly assigned into two groups into: test group including 11 patients who underwent small bore pigtail catheter drainage (14 Fr) and a control group including 11 patients who underwent conventional large bore chest tube drainage (30 Fr). Follow up of patients and extubation after resolution of pneumothorax was applied. Success of drainage was considered with full lung reexpansion and extubation with hospital discharge. Results: The frequency of success rate in the pigtail group and ICT group is nearly comparable (72.7%) and (63.6%) without significant difference. The frequency of complications following SSP drainage in patients of both studied groups was 36.7%. The more frequent complications among the failed cases was tube displacement and sepsis followed by surgical emphysema. The frequency of drainage complications was more frequent in failed cases of ICT than failed cases of the pigtail group with a significant difference. Among patients with successful outcome, pigtail catheter drainage of SSP was associated with significant and highly significant reduction in drainage duration and length of hospital stay in comparison to ICT drainage. Conclusion: Pigtail catheter drainage is nearly effective as ICT drainage of first episode of SSP. Pigtail catheter offers a safe, tolerable method for draining SSP with a shorter duration of drainage and hospital stay more than ICT. Increasing BMI is associated with drainage failure of SSP, where obesity is considered as a risk factor with high specificity for pigtail catheter drainage failure.

Keywords

• Pigtail catheter
• Secondary spontaneous pneumothorax
• Pleural space