Ambulatory Management of Primary Spontaneous Pneumothorax

Dawn O'Shea

July 30, 2020

Primary spontaneous pneumothorax can be managed on an outpatient basis, according to the findings of the UK Randomised Ambulatory Management of Primary Pneumothorax trial.

The open-label, randomised controlled trial recruited adults (aged 16-55 years) with symptomatic primary spontaneous pneumothorax from 24 UK hospitals during a period of three years. Patients were randomly assigned (1:1) to treatment with an ambulatory device (n=117) or standard guideline-based management comprising of aspiration, standard chest tube insertion or both (n=119).

As would be anticipated, at day 30, median hospitalisation, including readmission, was two days shorter with the ambulatory approach.

However, 110 (47%) of 236 patients had adverse events, including 64 (55%) in the ambulatory care arm and 46 (39%) in the standard care arm. All 14 serious adverse events occurred in patients who received ambulatory care, eight (57%) of which were related to the intervention, including an enlarging pneumothorax, asymptomatic pulmonary oedema and the device malfunctioning, leaking or dislodging.

Presenting the findings in the Lancet, the authors concluded that primary spontaneous pneumothorax can be managed for outpatients, using ambulatory devices in those who require intervention.

Hallifax RJ, McKeown E, Sivakumar P, Fairbairn I, Peter C, Leitch A, Knight M, Stanton A, Ijaz A, Marciniak S, Cameron J, Bhatta A, Blyth KG, Reddy R, Harris MC, Maddekar N, Walker S, West A, Laskawiec-Szkonter M, Corcoran JP, Gerry S, Roberts C, Harvey JE, Maskell N, Miller RF, Rahman NM. Ambulatory management of primary spontaneous pneumothorax: an open-label, randomised controlled trial. Lancet. 2020;396(10243):39-49. doi: 10.1016/S0140-6736(20)31043-6. PMID: 32622394 View full text.

This article originally appeared on Univadis, part of the Medscape Professional Network.

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