In patients with secondary spontaneous pneumothorax (SSP), ambulatory management with a flutter valve does not shorten the overall length of stay (LOS) compared with standard management, according to the results of a multicenter, open-label, randomized controlled trial (ISRCTN Registry: ISRCTN79956557) published in the European Respiratory Journal.1

According to research, SSP is the leading cause of admission in patients with spontaneous pneumothorax, and data have demonstrated that the duration of hospitalization in SSP is twice that of patients with primary spontaneous pneumothorax (PSP).1,2 Use of a one-way flutter valve, such as the Atrium Pneumostat (Atrium Medical; Merrimack, New Hampshire) chest tube valve, rather than current standard management of a chest tube attached to an underwater seal chamber, may increase mobilization and shorten hospital LOS.1,3

Researchers in the United Kingdom tested this hypothesis by comparing 21 patients with SSP who received ambulatory management with a flutter valve with 20 patients with SSP who received standard care.1 There was no difference in total length of hospitalization, including readmissions, in the first 30 days after randomization between the 2 groups. While the length of hospitalization for the initial admission was not significantly shorter in those receiving ambulatory care, high rates of early treatment failure in this group, with subsequent readmission, increased the overall LOS.

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However, the high rates of treatment failure were related to the original device used (Pleural Vent; Rocket Medical; Watford, UK). In contrast with the high rates of treatment failure in patients managed with the Pleural Vent, there were no early treatment failures and a “trend towards a shorter LOS in those managed with the Atrium Pneumostat.”

“In conclusion there was no difference in LOS between patients managed with ambulatory care compared to chest drain attached to underwater seal,” the study authors stated.1 “Our study has, however, shown early supportive evidence of safety in the attachment of an Atrium Pneumostat to an existing chest drain to ambulate patients with SSP. A dedicated trial using this device is now warranted.”

Disclosure: This clinical trial was supported by Rocket Medical UK. Please see the original reference for a full list of authors’ disclosures.  


1. Walker SP, Keenan E, Bintcliffe O, et al. Ambulatory management of secondary spontaneous pneumothorax: a randomised controlled trial. Eur Respir J. Published online December 17, 2020. doi:10.1183/13993003.03375-2020

2. Bobbio A, Dechartres A, Bouam S, et al. Epidemiology of spontaneous pneumothorax: gender-related differences. Thorax. 2015;70(7):653-658.

3. Brims FJH, Maskell NA. Ambulatory treatment in the management of pneumothorax: a systematic review of the literature. Thorax. 2013;68(7):664-669.