Lille.
Eur Respir J. 2014 Feb;43(2):582-90. doi: 10.1183/09031936.00179112. Epub 2013 Jun 13.
We prospectively assessed the safety and cost saving of a small-bore drain based procedure for outpatient management of first episodes of primary spontaneous pneumothorax. Patients were managed by observation alone or insertion of an 8.5-F "pig-tail" drain connected to a one-way valve, according to size and clinical tolerance of the pneumothorax. All patients were reassessed after 4 h, on the first working day after discharge and on day 7. Patients still exhibiting air leak on day 4 underwent thoracoscopy. The primary end-point was complete lung re-expansion at day 7. 60 consecutive patients entered the study. 48 (80%) met the definition of large pneumothorax. The success rate was 83%. The 1-year recurrence rate was 17%. 36 (60%) patients were discharged after 4 h and 50% had full outpatient management. No severe complication was observed. The mean ± SD length of hospitalisation was 2.3 ± 3.1 days. This policy resulted in about a 40% reduction in hospital stay-related costs. The present study supports the use of a single system combined with a well-defined management algorithm including safe discharge criteria, as an alternative to manual aspiration or chest tube drainage. This approach participates in healthcare cost-savings.
我们前瞻性评估了一种基于小口径引流管的方法，用于门诊治疗首次原发性自发性气胸，以确保安全和节省成本。根据气胸的大小和临床耐受程度，患者可单独观察或插入 8.5-F“猪尾”引流管并连接单向阀进行治疗。所有患者在 4 小时后、出院后的第一个工作日以及第 7 天进行重新评估。如果第 4 天仍有气胸漏出的患者，则进行胸腔镜检查。主要终点是第 7 天完全肺复张。60 例连续患者进入研究。48 例（80%）符合大疱性气胸的定义。成功率为 83%。1 年复发率为 17%。36 例（60%）患者在 4 小时后出院，50%的患者进行了完全门诊管理。未观察到严重并发症。平均住院时间为 2.3 ± 3.1 天。这一政策使与住院相关的费用减少了约 40%。本研究支持使用单一系统并结合明确的管理算法，包括安全出院标准，作为手动抽吸或胸管引流的替代方法。这种方法有助于节省医疗保健成本。
