A Systematic Review and Meta-Analysis Comparing Pigtail Catheter and Chest Tube as the Initial Treatment for Pneumothorax.
Chest. 2018 Feb 13;:
Authors: Chang SH, Kang YN, Chiu HY, Chiu YH
BACKGROUND: The optimal initial treatment approach for pneumothorax remains controversial. This systemic review and meta-analysis investigated the effectiveness of small-bore pigtail catheter (PC) drainage in comparison with that of large-bore chest tube (LBCT) drainage as the initial treatment approach for all subtypes of pneumothorax.
METHODS: We systematically searched PubMed and Embase for observational studies and randomized controlled trials published up to October 9, 2017, that compared PC and LBCT as the initial treatment for pneumothorax. The investigative outcomes included success rates, recurrence rates, complication rates, drainage duration, and hospital stay. (CRD42017078481) RESULTS: Of the 11 included studies (875 patients), the success rate was similar in the PC (79·84%) and LBCT groups (82·87%), with a risk ratio of 0·99 (95% CI 0·93-1·05, I2 = 0%). Specifically, PC drainage was associated with a significantly lower complication rate following pneumothorax than LBCT drainage (Peto odds ratio 0·49 [95% CI 0·28-0·85], I2 = 0%). In the spontaneous subgroup, PC drainage was associated with a significantly shorter drainage duration (mean difference = -1·51 [95% CI -2·93 to -0·09]) and hospital stay (mean difference = -2·54 [95% CI -3·16 to -1·92], p < 0·001) than LBCT group.
CONCLUSIONS: Collectively, results of the meta-analysis suggest PC drainage may be considered as the initial treatment option for patients with primary or secondary spontaneous pneumothorax. Ideally, randomized controlled trials are needed to compare PC versus LBCT among different subgroups of pneumothorax patients, which may ultimately improve clinical care and management for patients with pneumothorax. (Registration of study protocol: PROSPERO, CRD42017078481).
PMID: 29452099 [PubMed - as supplied by publisher]