Pigtail catheters vs large-bore chest tubes for management of secondary spontaneous pneumothoraces in adults

Tsai, Wen-Kai; Chen, Wei; Lee, Jen-chih; Cheng, Wei-Erh; Chen, Chia-Hung; Hsu, Wu-Huei; Shih, Chuen-Ming

doi:10.1016/j.ajem.2006.04.006

« Previous Next »American Journal of Emergency Medicine
Volume 24, Issue 7 , Pages 795-800, November 2006

Pigtail catheters vs large-bore chest tubes for management of secondary spontaneous pneumothoraces in adults

Wen-Kai Tsai, MD
- Departments of Internal Medicine, Divisions of Chest Medicine, China Medical University Beigang Hospital, Yulin 651, Taiwan
Wei Chen, MD
- Departments of Internal Medicine, Divisions of Pulmonary and Critical Care Medicine, China Medical University Hospital, Taichung 404, Taiwan
Jen-chih Lee, MD
- Departments of Internal Medicine, Divisions of Pulmonary and Critical Care Medicine, China Medical University Hospital, Taichung 404, Taiwan
Wei-Erh Cheng, MD
- Departments of Internal Medicine, Divisions of Pulmonary and Critical Care Medicine, China Medical University Hospital, Taichung 404, Taiwan
Chia-Hung Chen, MD
- Departments of Internal Medicine, Divisions of Pulmonary and Critical Care Medicine, China Medical University Hospital, Taichung 404, Taiwan
Wu-Huei Hsu, MD
- Departments of Internal Medicine, Divisions of Chest Medicine, China Medical University Beigang Hospital, Yulin 651, Taiwan
Chuen-Ming Shih, MD, PhD
- Departments of Internal Medicine, Divisions of Pulmonary and Critical Care Medicine, China Medical University Hospital, Taichung 404, Taiwan
- School of Respiratory Therapy, China Medical University, Taichung 404, Taiwan
- Corresponding author. Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, China Medical University Hospital, Taichung 404, Taiwan. Fax: +886 4 22077618.

Received 21 March 2006; received in revised form 23 April 2006; accepted 25 April 2006.

Abstract

It is still uncertain if large-bore chest tubes (20F-28F) is superior to pigtail catheter (10F-14F) in terms of the management of secondary spontaneous pneumothoraces (SSP).This study was designed to compare the efficacy and safety associated with placement of large-bore chest tubes vs pigtail catheters in adults experiencing the first episode of SSP. We conducted a retrospective chart review of 91 patients experiencing the first episode of SSP in a university hospital over a 3.5-year period who received treatment by either a large-bore chest tube or a pigtail catheter. Any patient who was younger than 18 years or experiencing mechanical ventilation–related barotraumas or pyopneumothorax was excluded from this study. Various parameters including demographical characteristics, size of pneumothorax, complications, time of pigtail or chest tube extubation, and length of hospital stay were collected and analyzed. Among the enrolled 91 patients, including 76 (83.5%) men with a mean age of 60 ± 19 years, 69 were initially treated with a pigtail, and 22 patients received conventional chest tubes. Fifty patients (72.5%) undergoing the pigtail drainage and 16 (72.7%) undergoing large-bore chest tube treatment of SSP were successfully treated (P = .88). In addition, there was no significant difference in terms of length of hospital stay, extubation time, recurrence rate, and complication. Pigtail catheters offer a safe and effective alternative for large-bore chest tubes to adult patients experiencing the first episode of SSP, and we strongly suggested that pigtail tube drainage should be considered as the initial treatment of choice.