Department of Surgery, Foothills Medical Center, University of Calgary, Calgary, Alberta, Canada.
Department of Thoracic Surgery, Sherbrooke University, Sherbrooke, Quebec, Canada.
Am J Surg. 2021 Jun;221(6):1252-1258. doi: 10.1016/j.amjsurg.2021.02.012. Epub 2021 Feb 20.
Patients with occult pneumothorax (OPTX) requiring positive-pressure ventilation (PPV) face uncertain risks of tension pneumothorax or chest drainage complications.
Adults with traumatic OPTXs requiring PPV were randomized to drainage/observation, with the primary outcome of composite "respiratory distress" (RD)).
Seventy-five (75) patients were randomized to observation, 67 to drainage. RD occurred in 38% observed and 25% drained (p = 0.14; Power = 0.38), with no mortality differences. One-quarter of observed patients failed, reaching 40% when ventilated >5 days. Twenty-three percent randomized to drainage had complications or ineffectual drains.
RD was not significantly different with observation. Thus, OPTXs may be cautiously observed in stable patients undergoing short-term PPV when prompt "rescue drainage" is immediately available. As 40% of patients undergoing prolonged (≥5 days) ventilation (PPPV) require drainage, we suggest consideration of chest drainage performed with expert guidance to reduce risk of chest tube complications.
Therapeutic study, level II.
需要正压通气 (PPV) 的隐匿性气胸 (OPTX) 患者存在张力性气胸或胸腔引流并发症的不确定风险。
需要 PPV 的外伤性 OPTX 成人患者随机分为引流/观察组，主要结局为复合“呼吸窘迫” (RD)。
75 例患者被随机分配到观察组，67 例患者被随机分配到引流组。观察组中 RD 发生率为 38%，引流组为 25% (p=0.14; 功率=0.38)，死亡率无差异。四分之一的观察组患者治疗失败，当通气时间>5 天时，RD 发生率达到 40%。23%随机引流的患者出现并发症或引流无效。
观察组的 RD 无显著差异。因此，当迅速提供“抢救性引流”时，稳定的接受短期 PPV 的 OPTX 患者可谨慎观察。由于 40%接受长时间（≥5 天）通气 (PPPV) 的患者需要引流，我们建议考虑在专家指导下进行胸腔引流，以降低胸腔管并发症的风险。
治疗研究，II 级。
