What is the role of a one-way valve system in the management of pneumothorax?

Updated: Apr 28, 2020
  • Author: Brian J Daley, MD, MBA, FACS, FCCP, CNSC; Chief Editor: Mary C Mancini, MD, PhD, MMM  more...
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Answer

The typical goal of inserting one-way valve systems is to avoid hospital admission and still treat the spontaneous pneumothorax. One-way valves may also expedite hospital discharge and be used during transport of an injured patient.

A Heimlich valve is a one-way, rubber flutter valve that allows for complete evacuation of air that is not under tension. The proximal end attaches to the chest tube or catheter, and the distal end connects to a suction device or is left open to the atmosphere. Heimlich valves do not require suction and thus eliminate the chance of a tension pneumothorax; they also allow greater mobility and less discomfort for the patient. By decreasing the length of the hospital stay and allowing for outpatient care, medical costs are reduced as well.

In a pilot study, Marquette et al determined that using a serial-steps approach with a single system (small-caliber catheter/Heimlich valve) in patients with a first episode of PSP was as effective as simple manual needle aspiration or a conventional chest tube thoracotomy. [61] In 41 thin, young, smoking males, a one-way Heimlich valve was connected to the catheter, allowing the air to flow spontaneously outward for 24-48 hours; thereafter, if the lung failed to re-expand, wall suction was applied. Patients with an air leak persisting for more than 4 days were referred for surgery.

At 24 hours, the success rate was 61%, and at 1 week, it had risen to 85%; the actuarial 1-year recurrence rate was 24%. [61] When 24-hour and 1-week success rates and recurrence at 12 months were taken as end points, the method described above was effective as simple manual needle aspiration or a conventional chest tube thoracotomy. [61]

Heimlich valves are widely used in the care of patients with AIDS who have a median length of 20 days of chest tube placement to facilitate care and mobility.


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