The George Washington University Medical Center, Department of Emergency Medicine, Washington, DC, USA.
Resuscitation. 2010 Sep;81(9):1063-8. doi: 10.1016/j.resuscitation.2010.04.030.
Occult pneumothorax (OPTX) is defined as a pneumothorax seen on computed tomography but not apparent on supine plain radiography. Though increasingly common, the acute management of OPTX after trauma remains controversial. This evidence-based review evaluates the existing evidence regarding the safety and efficacy of observation as compared to tube thoracostomy (TT) for management of OPTX in emergency department trauma patients.
The authors searched MEDLINE, EMBASE, the Cochrane Library, and other databases.
studies of adult or pediatric trauma victims at first presentation after blunt or penetrating injury (population), randomized to observation (intervention) or TT (comparison). Studies that enrolled patients on positive pressure ventilation were included but those that enrolled hemodynamically unstable patients were excluded. Outcomes of interest included progression of OPTX, mortality, complications (pneumonia, empyema), and length of stay in hospital and intensive care unit (ICU).
A total of 411 articles were identified. After applying the inclusion/exclusion criteria, 3 randomized trials enrolling a total of 101 patients were found to have acceptable quality standards suitable for analysis. The included studies did not reveal any significant difference between observation and TT in regards to progression of OPTX, risk of pneumonia, or length of stay in hospital or ICU. Mortality risk and empyema rate were also not different in the single studies that reported those outcomes.
The existing evidence leads to the conclusion that observation is at least as safe and effective as tube thoracostomy for management of occult pneumothorax.
隐匿性气胸（OPTX）定义为 CT 上可见但仰卧位平片上未见气胸。尽管 OPTX 在创伤后越来越常见，但对于其急性管理仍存在争议。本循证综述评估了现有证据，比较了观察与胸腔引流管（TT）治疗急诊创伤患者 OPTX 的安全性和有效性。
作者检索了 MEDLINE、EMBASE、Cochrane 图书馆和其他数据库。
钝性或穿透性损伤后首次就诊的成人或儿童创伤患者（人群），随机分为观察组（干预）或 TT 组（比较）。纳入了使用正压通气的患者，但排除了血流动力学不稳定的患者。感兴趣的结局包括 OPTX 进展、死亡率、并发症（肺炎、脓胸）以及住院和重症监护病房（ICU）的住院时间。
共确定了 411 篇文章。应用纳入/排除标准后，发现 3 项共纳入 101 例患者的随机试验具有可接受的质量标准，适合进行分析。纳入的研究在 OPTX 进展、肺炎风险或住院和 ICU 住院时间方面，观察组与 TT 组之间没有显著差异。在报告这些结局的单篇研究中，死亡率风险和脓胸发生率也没有差异。
现有证据表明，观察与 TT 治疗隐匿性气胸至少同样安全有效。
