Reexpansion Pulmonary Edema after Initial Treatment of Primary Spontaneous Pneumothorax: Small Bore Catheterization versus Chest Tube Thoracostomy

Ko, Seok Hoon; Park, Hyun Kyung; Lee, Chang Min; Park, Sung Hyuk; Jung, Woong; Kim, Myung Chun; Ko, Young Gwan; Kim, Dae Hyun

J Korean Soc Emerg Med > Volume 26(6); 2015 > Article

Original Article

Journal of The Korean Society of Emergency Medicine 2015;26(6): 577-584.

일차 자발기흉 환자에서 소구경 카테터 흉강삽입술과 가슴관 흉강삽관술의 재팽창성 폐부종 발생 비교

고석훈¹, 박현경¹, 이창민¹, 박성혁¹, 정웅¹, 김명천¹, 고영관¹, 김대현²

¹경희대학교 의과대학 강동경희대병원 응급의학과
²경희대학교 의과대학 강동경희대병원 흉부외과

Reexpansion Pulmonary Edema after Initial Treatment of Primary Spontaneous Pneumothorax: Small Bore Catheterization versus Chest Tube Thoracostomy

Seok Hoon Ko¹, Hyun Kyung Park¹, Chang Min Lee¹, Sung Hyuk Park¹, Woong Jung¹, Myung Chun Kim¹, Young Gwan Ko¹, Dae Hyun Kim²

¹Department of Emergency Medicine, Kyung Hee University Hospital at Kangdong, College of Medicine, Kyung Hee University, Seoul, Korea
²Department of Thoracic and Cardiovascular Surgery, Kyung Hee University Hospital at Kangdong, College of Medicine, Kyung Hee University, Seoul, Korea

Correspondence

Hyun Kyung Park ,Tel: 02) 440-7790, Fax: 02) 440-7799, Email: emhyun@khnmc.or.kr,

Received: July 31, 2015; Revised: August 4, 2015 Accepted: September 26, 2015. Published online: December 30, 2015.

ABSTRACT

Purpose:
Reexpansion pulmonary edema (REPE) is a rare but potentially lethal complication of treatment for pneumothorax. This study was designed to compare the frequency of REPE after treatment of primary spontaneous pneumothorax (PSP) with 6 French (Fr) small bore catheterization and 14-20 Fr chest tube thoracostomy.
Method:
The medical records of PSP patients treated with thoracostomy from January 2010 to May 2015 were reviewed retrospectively. We compared the group treated using a 6 Fr small bore catheter with the group treated using a 14-20 Fr chest tube for clinical and demographic factors. The main outcome was the frequency of REPE between the two groups.
Results:
A total of 196 patients were enrolled. No significant differences in catheter indwelling time, lengths of hospital stay, and treatment failures were observed between the two groups. REPE developed in 21 patients (10.7%). The frequencies of REPE after 6 Fr small bore catheter and 14-20 Fr chest tube were 6.0% (7 of 114 patients) and 17.1% (14 of 82 patients), respectively (p=0.015). In logistic regression analysis, drainage via 14-20 Fr chest tube showed significant correlation with the occurrence of REPE (odds ratio=3.03, p=0.038).
Conclusion:
A 6 Fr small bore catheter offers a safe and effective alternative to a chest tube for treatment of pneumothorax. We suggest that drainage via a small bore catheter should be considered as the initial treatment of choice for PSP patients in terms of frequency of development REPE.

Key words: Pulmonary edema, Pneumothorax, Catheterization, Chest tubes