Patients diagnosed with spontaneous pneumothorax may experience shorter drainage duration and hospital stay with the use of a small-bore pigtail catheter (PC) compared with a large-bore chest tube (LBCT), according to a study published in CHEST.
Researchers conducted a systematic review and meta-analysis of the literature to determine the effectiveness of using a PC vs a LBCT drainage system as the initial treatment for patients diagnosed with different subtypes of pneumothoraces. A total of 11 randomized controlled trials and cohort studies were included in the analysis, which included 875 patients from 4 different continents (Africa, Asia, Europe, and North America).
Researchers found the overall success rates for treating all types of pneumothoraces in the 11 studies to be very similar in individuals treated with PC (n=293/367; 79.84%) compared with LBCT (n=421/508; 82.87%) between the 2 treatment groups (risk ratio [RR], 0.99; 95% CI, 0.93-1.05; I2=0%). A subgroup analysis between the different types of pneumothoraces was performed that did not find significantly different results between groups.
Recurrence rates were found to be lower, but not statistically significant, in the PC group (n=33/157; 21.02%) compared with the LBCT group (n=43/143; 30.07%; RR, 0.78; 95% CI, 0.57-1.09; I2=0%). In 9 of the studies, when PC was compared with LBCT for complication rates, the PC group (n=32/278; 11.51%) had a lower complication rate than the LBCT group (n=72/436; 16.51%), but the results were mainly driven by individuals with a spontaneous pneumothorax (Peto odds ratio, 0.63; 95% CI, 0.39-1.03; I2=26%). Subgroups for a traumatic pneumothorax and a single trial that included a mixed pneumothoraces subgroup analysis found no significant differences in complication rates observed between the 2 groups.
Individuals treated with PC compared with LBCT experienced an overall shorter drainage duration (mean difference [MD], −1.03; 95% CI, −1.84 to −0.23; P =.01; I2=51%). A subgroup analysis assessing drainage duration did not show a significant difference between groups in the overall mixed pneumothorax subgroup or for those with a traumatic pneumothorax (MD, −1.70 [95% CI, −4.50 to 1.10] and MD, −0.40 [95% CI, −0.92 to 0.12], respectively).
In addition, the hospital length of stay was found to be shorter in individuals treated with PC compared with LBCT (MD, −2.54; 95% CI, −3.16 to −1.92; P <.001; I2=0%). The researchers also noted that results were driven by spontaneous pneumothorax. No significant differences were identified between groups after conducting a subgroup analysis.
A final set of subgroup analyses was performed to determine whether results were affected by study design or study region. Success rates, recurrence rates, and complication rates were not found to be different between the 2 groups, regardless of region or study type. Subgroup analysis of study designs found individuals in the PC group were associated with a shorter drainage duration than those in the LBCT group (MD, −2.50; 95% CI, −4.00 to −1.00; P <.001), with the subgroup analysis in Asia and United States finding that individuals in the PCT group had a shorter hospital length of stay than those in the LBCT group.
Last, a subgroup analysis between types of pneumothoraces demonstrated no differences between groups for success and recurrence in individuals with a spontaneous pneumothorax. However, individuals with a secondary pneumothorax treated with PC compared to LBCT drainage had fewer complications (Peto odds ratio, 0.13; 95% CI, 0.03-0.57; P =.007; I2=51%) and a shorter drainage duration (MD, −2.38; 95% CI, −3.69 to −1.07; P <.001; I2=0%).
In conclusion, researchers suggested that PC drainage is as effective as LBCT drainage for the treatment of a pneumothorax, yet was associated with shorter drainage duration and hospital length of stay, as well as fewer complications in individuals with a secondary spontaneous pneumothorax. On the basis of this systematic review, clinicians should consider the use of PC as the initial treatment for individuals with a primary or secondary pneumothorax.
Chang SH, Kang YN, Chiu HY, Chiu YH. A systematic review and meta-analysis comparing pigtail catheter and chest tube as the initial treatment for pneumothorax [published online February 13, 2018]. CHEST. doi:10.1016/j.chest.2018.01.048