A Systematic Review and Meta-Analysis Comparing Pigtail Catheter and Chest Tube as the Initial Treatment for Pneumothorax

Su Huan Chang, Yi No Kang, Hsin Yi Chiu, Yu Han Chiu

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

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 compared with that of large-bore chest tube (LBCT) drainage as the initial treatment approach for all subtypes of pneumothorax. Methods: PubMed and Embase were systematically searched 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. Results: Of the 11 included studies (875 patients), the success rate was similar in the PC (79.84%) and LBCT (82.87%) groups, with a risk ratio of 0.99 (95% CI, 0.93 to 1.05; I2 = 0%). Specifically, PC drainage was associated with a significantly lower complication rate following spontaneous pneumothorax than LBCT drainage (Peto odds ratio: 0.49 [95% CI, 0.28 to 0.85]; I2 = 29%). 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 <.001) than the 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 vs LBCT among different subgroups of patients with pneumothorax, which may ultimately improve clinical care and management for these patients. Trial Registry: PROSPERO; No.: CRD42017078481; URL: https://www.crd.york.ac.uk/prospero/.

Original languageEnglish
Pages (from-to)1201-1212
Number of pages12
JournalChest
Volume153
Issue number5
DOIs
Publication statusPublished - May 1 2018

Fingerprint

Chest Tubes
Pneumothorax
Meta-Analysis
Drainage
Catheters
Therapeutics
Length of Stay
Randomized Controlled Trials
Odds Ratio
Patient Care Management
PubMed
Observational Studies
Registries
Recurrence

Keywords

  • chest tube
  • pigtail
  • pneumothorax
  • thoracentesis
  • thoracostomy

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

A Systematic Review and Meta-Analysis Comparing Pigtail Catheter and Chest Tube as the Initial Treatment for Pneumothorax. / Chang, Su Huan; Kang, Yi No; Chiu, Hsin Yi; Chiu, Yu Han.

In: Chest, Vol. 153, No. 5, 01.05.2018, p. 1201-1212.

Research output: Contribution to journalArticle

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abstract = "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 compared with that of large-bore chest tube (LBCT) drainage as the initial treatment approach for all subtypes of pneumothorax. Methods: PubMed and Embase were systematically searched 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. Results: Of the 11 included studies (875 patients), the success rate was similar in the PC (79.84{\%}) and LBCT (82.87{\%}) groups, with a risk ratio of 0.99 (95{\%} CI, 0.93 to 1.05; I2 = 0{\%}). Specifically, PC drainage was associated with a significantly lower complication rate following spontaneous pneumothorax than LBCT drainage (Peto odds ratio: 0.49 [95{\%} CI, 0.28 to 0.85]; I2 = 29{\%}). 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 <.001) than the 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 vs LBCT among different subgroups of patients with pneumothorax, which may ultimately improve clinical care and management for these patients. Trial Registry: PROSPERO; No.: CRD42017078481; URL: https://www.crd.york.ac.uk/prospero/.",
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