Preliminary Report of a Prospective, Randomized Trial of Underwater Seal for Spontaneous and Iatrogenic Pneumothorax

Michael F. Reed, Jefferson M. Lyons, Fred A. Luchette, Jeffery A. Neu, John A. Howington

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

Background: Management of pneumothorax has traditionally been tube thoracostomy and -20 cm H2O suction. The purpose of our study was to determine if underwater seal in iatrogenic and spontaneous pneumothoraces is safe and efficacious and if small-caliber chest tubes are appropriate for routine use in pneumothorax. Study design: From April 2001 through October 2003 patients with iatrogenic or spontaneous pneumothorax were enrolled in this prospective, randomized trial. Small-bore catheters were inserted. Initial management was 1 hour -20 cm H2O suction, chest radiography, and randomization into -20 cm H2O suction, -10 cm H2O suction, or underwater seal. Tubes were discontinued at 48 hours if there were no pneumothoraces and no air leaks. Those with air leaks and recurrent pneumothoraces persisting 5 days underwent pleurodesis. The primary end point was successful chest tube removal at 48 hours. The secondary end point was need for pleurodesis. Results: Twenty-nine patients were analyzed. Seven were randomized to -20 cm H2O suction, 11 to -10 cm H2O suction, and 11 to underwater seal. Most (59%, 17 of 29) chest tubes were successfully removed 48 hours after placement: 57% (4 of 7) after -20 cm H2O suction, 73% (8 of 11) after -10 cm H2O suction, and 45% (5 of 11) after underwater seal (p = 0.48). Seven (24%) required pleurodesis: 29% (2 of 7) after -20 cm H2O suction, 27% (3 of 11) after -10 cm H2O suction, and 18% (2 of 11) after underwater seal (p = 0.70). Conclusions: Early underwater seal appears to be safe for treating iatrogenic and spontaneous pneumothoraces. It can achieve comparable frequencies of early chest tube removal and avoidance of operation compared with traditional management. A larger, multi-institutional study should be performed to demonstrate that pneumothorax treatment can effectively incorporate small-caliber tubes and underwater seal.

Original languageEnglish (US)
Pages (from-to)84-90
Number of pages7
JournalJournal of the American College of Surgeons
Volume204
Issue number1
DOIs
StatePublished - Jan 1 2007

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Suction
Pneumothorax
Chest Tubes
Pleurodesis
Air
Thoracostomy
Random Allocation
Radiography
Thorax
Catheters

All Science Journal Classification (ASJC) codes

  • Surgery

Cite this

Reed, Michael F. ; Lyons, Jefferson M. ; Luchette, Fred A. ; Neu, Jeffery A. ; Howington, John A. / Preliminary Report of a Prospective, Randomized Trial of Underwater Seal for Spontaneous and Iatrogenic Pneumothorax. In: Journal of the American College of Surgeons. 2007 ; Vol. 204, No. 1. pp. 84-90.
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title = "Preliminary Report of a Prospective, Randomized Trial of Underwater Seal for Spontaneous and Iatrogenic Pneumothorax",
abstract = "Background: Management of pneumothorax has traditionally been tube thoracostomy and -20 cm H2O suction. The purpose of our study was to determine if underwater seal in iatrogenic and spontaneous pneumothoraces is safe and efficacious and if small-caliber chest tubes are appropriate for routine use in pneumothorax. Study design: From April 2001 through October 2003 patients with iatrogenic or spontaneous pneumothorax were enrolled in this prospective, randomized trial. Small-bore catheters were inserted. Initial management was 1 hour -20 cm H2O suction, chest radiography, and randomization into -20 cm H2O suction, -10 cm H2O suction, or underwater seal. Tubes were discontinued at 48 hours if there were no pneumothoraces and no air leaks. Those with air leaks and recurrent pneumothoraces persisting 5 days underwent pleurodesis. The primary end point was successful chest tube removal at 48 hours. The secondary end point was need for pleurodesis. Results: Twenty-nine patients were analyzed. Seven were randomized to -20 cm H2O suction, 11 to -10 cm H2O suction, and 11 to underwater seal. Most (59{\%}, 17 of 29) chest tubes were successfully removed 48 hours after placement: 57{\%} (4 of 7) after -20 cm H2O suction, 73{\%} (8 of 11) after -10 cm H2O suction, and 45{\%} (5 of 11) after underwater seal (p = 0.48). Seven (24{\%}) required pleurodesis: 29{\%} (2 of 7) after -20 cm H2O suction, 27{\%} (3 of 11) after -10 cm H2O suction, and 18{\%} (2 of 11) after underwater seal (p = 0.70). Conclusions: Early underwater seal appears to be safe for treating iatrogenic and spontaneous pneumothoraces. It can achieve comparable frequencies of early chest tube removal and avoidance of operation compared with traditional management. A larger, multi-institutional study should be performed to demonstrate that pneumothorax treatment can effectively incorporate small-caliber tubes and underwater seal.",
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Preliminary Report of a Prospective, Randomized Trial of Underwater Seal for Spontaneous and Iatrogenic Pneumothorax. / Reed, Michael F.; Lyons, Jefferson M.; Luchette, Fred A.; Neu, Jeffery A.; Howington, John A.

In: Journal of the American College of Surgeons, Vol. 204, No. 1, 01.01.2007, p. 84-90.

Research output: Contribution to journalArticle

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T1 - Preliminary Report of a Prospective, Randomized Trial of Underwater Seal for Spontaneous and Iatrogenic Pneumothorax

AU - Reed, Michael F.

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N2 - Background: Management of pneumothorax has traditionally been tube thoracostomy and -20 cm H2O suction. The purpose of our study was to determine if underwater seal in iatrogenic and spontaneous pneumothoraces is safe and efficacious and if small-caliber chest tubes are appropriate for routine use in pneumothorax. Study design: From April 2001 through October 2003 patients with iatrogenic or spontaneous pneumothorax were enrolled in this prospective, randomized trial. Small-bore catheters were inserted. Initial management was 1 hour -20 cm H2O suction, chest radiography, and randomization into -20 cm H2O suction, -10 cm H2O suction, or underwater seal. Tubes were discontinued at 48 hours if there were no pneumothoraces and no air leaks. Those with air leaks and recurrent pneumothoraces persisting 5 days underwent pleurodesis. The primary end point was successful chest tube removal at 48 hours. The secondary end point was need for pleurodesis. Results: Twenty-nine patients were analyzed. Seven were randomized to -20 cm H2O suction, 11 to -10 cm H2O suction, and 11 to underwater seal. Most (59%, 17 of 29) chest tubes were successfully removed 48 hours after placement: 57% (4 of 7) after -20 cm H2O suction, 73% (8 of 11) after -10 cm H2O suction, and 45% (5 of 11) after underwater seal (p = 0.48). Seven (24%) required pleurodesis: 29% (2 of 7) after -20 cm H2O suction, 27% (3 of 11) after -10 cm H2O suction, and 18% (2 of 11) after underwater seal (p = 0.70). Conclusions: Early underwater seal appears to be safe for treating iatrogenic and spontaneous pneumothoraces. It can achieve comparable frequencies of early chest tube removal and avoidance of operation compared with traditional management. A larger, multi-institutional study should be performed to demonstrate that pneumothorax treatment can effectively incorporate small-caliber tubes and underwater seal.

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