Photo Credit: ALIOUI Mohammed Elamine

The following is a summary of “Simple aspiration for spontaneous pneumothorax in adults: A systematic review and meta-analysis of randomized controlled trials,” published in the June 2024 issue of Emergency Medicine by Cheng, et al.

Spontaneous pneumothorax (SP) is a common medical condition, and the optimal management strategies for adult SP remain contentious. For a meta-analysis, researchers sought to evaluate the clinical efficacy and safety of simple aspiration (SA) compared to intercostal tube drainage (ITD) in adult patients with SP.

They systematically searched EMBASE, Medline, and the Cochrane Central Register of Controlled Trials via Ovid SP up to June 2023 for randomized controlled trials (RCTs) comparing SA with ITD in adult patients with SP. They included studies that reported relevant outcomes of interest.

The search identified 1,447 citations, from which 10 RCTs involving 1,044 participants met the inclusion criteria. Compared to the ITD group, the SA group showed a significantly lower initial success rate for managing SP (OR 0.63, 95% CI [0.47–0.86]; P = 0.004). However, SA was associated with shorter hospital stays (mean difference -2.05 days, 95% CI [−2.66 – −1.44]; P < 0.001) and a reduced need for surgical intervention (P = 0.03). There were no significant differences between SA and ITD in the incidence of subcutaneous emphysema (P = 0.32), bleeding (P = 0.26), or wound infection (P = 0.07). Subgroup analysis for primary spontaneous pneumothorax (PSP) patients did not reveal significant differences in the initial success rate, 1-week success rate, or adverse events between SA and ITD.

In adult patients with SP, SA resulted in a lower initial success rate compared to ITD but was associated with shorter hospitalization and reduced need for surgical intervention. The incidence of adverse events did not differ significantly between SA and ITD. The findings supported considering SA as a viable alternative to ITD in the management of adult SP, emphasizing the importance of individualized treatment decisions based on clinical circumstances and patient preferences.

Reference: sciencedirect.com/science/article/abs/pii/S073567572400130X