Tebb Zachary D, Talley Brad, Macht Marlow, Richards David
Int J Emerg Med. 2010 Aug 20;3(4):391-7. doi: 10.1007/s12245-010-0190-z.
Traumatic pneumothoraces are common. Many are managed with tube thoracostomy. However, there is a high complication rate from chest tube placement, particularly in patients with HIV, TB, or both.
We sought to investigate the literature on the conservative management of traumatic pneumothorax in patients with HIV and/or TB.
The literature search was broken into two parts. In the first part, we searched for articles comparing tube thoracostomy versus conservative management in traumatic pneumothorax. In the second part, we sought articles describing the incidence and outcome of pneumothoraces in patients with pre-existing HIV or tuberculosis. In both, relevant articles were reviewed, and citations were hand-searched.
For the first portion, we identified 384 papers. From these, six studies were relevant. For the second portion, we identified 327 articles. A total of four unique articles were selected. The heterogeneity of the studies did not allow any pooled analysis. The studies of conservative management demonstrated a low percentage of patients with small pneumothoraces (most often <1.5 cm or less than 10%) later required tube thoracostomy for clinical deterioration (range 6-25%). No studies focused exclusively on pneumothoraces in patients with TB. In patients with HIV, there were no prospective trials of conservative management. Mortality for all HIV-infected patients with pneumothorax was high (25-50%), and the rate of complications from tube thoracostomy was also high. Pneumocystits carinii pneumonia (PCP) independently increased mortality.
A review of the literature suggests that selected small pneumothoraces may be managed conservatively and that there is a high rate of complications related to tube thoracostomy in HIV patients. We propose a trial of the safety of conservative management of traumatic pneumothoraces in an area with a high prevalence of HIV and TB.
创伤性气胸很常见。许多患者采用胸腔闭式引流术进行治疗。然而，胸腔置管的并发症发生率很高，尤其是在感染HIV、结核病或同时感染这两种疾病的患者中。
我们试图研究关于HIV和/或结核病患者创伤性气胸保守治疗的文献。
文献检索分为两部分。第一部分，我们搜索比较创伤性气胸胸腔闭式引流术与保守治疗的文章。第二部分，我们查找描述已有HIV或结核病患者气胸的发生率和转归的文章。在这两部分检索中，对相关文章进行了综述，并人工检索了参考文献。
对于第一部分，我们识别出384篇论文。其中，6项研究相关。对于第二部分，我们识别出327篇文章。总共挑选出4篇独特的文章。研究的异质性不允许进行任何汇总分析。保守治疗的研究表明，小气胸患者（大多数情况下<1.5 cm或小于10%）中，因临床病情恶化而需要进行胸腔闭式引流术的比例较低（范围为6%-25%）。没有研究专门关注结核病患者的气胸情况。在HIV患者中，没有保守治疗的前瞻性试验。所有感染HIV的气胸患者死亡率很高（25%-50%），胸腔闭式引流术的并发症发生率也很高。卡氏肺孢子虫肺炎（PCP）独立增加死亡率。
文献综述表明，部分小气胸可以采用保守治疗，且HIV患者胸腔闭式引流术相关并发症发生率很高。我们提议在HIV和结核病高流行地区进行创伤性气胸保守治疗安全性的试验。
