Chest tube placement and needle aspiration were both acceptable treatments for primary spontaneous pneumothorax, although there were differences in hospital stay length and adverse events, according to the results of a recent study published in the Annals of Emergency Medicine.
Data from randomized control trials comparing simple (needle) aspiration vs intercostal tube drainage (chest tube placement) for the management of primary spontaneous pneumothorax were obtained after a literature search of Cochrane Library, MEDLINE, EMBASE, the World Health Organization International Clinical Trials Registry, and ClinicalTrials.gov.
A total of 435 patients from 6 randomized controlled trials were included in the analysis. Chest tube placement had a higher immediate success rate but was associated with a longer hospital length of stay. In addition, there were no differences in 1-year success and hospitalization rates or patient satisfaction between the 2 treatments. However, needle aspiration was associated with fewer adverse events.
The study authors wrote, “For years there has been controversy about how to manage primary spontaneous pneumothorax, mostly because of a lack of high-quality evidence.”
They also noted that although the review supports both chest tube placement and needle aspiration as reasonable treatment options, “until further high-quality comparative effectiveness research is performed, a decisive statement about the superiority of chest tube placement versus needle aspiration cannot be made.”
Tupchong K. Update: is needle aspiration better than chest tube placement for the management of primary spontaneous pneumothorax? [published online March 31, 2018]. Ann Emerg Med. doi:10.1016/j.annemergmed.2018.02.025