Abstract
Background: Conservative observation with/without oxygen supplementation, aspiration, or tube drainage is selected as an initial treatment for spontaneous pneumothorax. In this study, we have examined the efficacy of initial management for cessation of air leak and prevention of recurrence separately, with consideration of the degree of lung collapse.Methods: Spontaneous pneumothorax in patients who underwent initial management in our institute between January 2006 and December 2015 were included in this retrospective, single-institutional study. Multivariate analyses were conducted to identify risk factors related to the persistent air leak after initial treatment and those related to ipsilateral recurrence after last treatment.Results: In the multivariate analysis for predicting persistent air leak after first treatment, repeated episode of ipsilateral pneumothorax (p = 0.0022), high degree of lung collapse (p = 0.032), and bulla formation (p < 0.0001) were the statistically significant risk factors for treatment failure. Recurrence of ipsilateral pneumothorax was observed in 126 cases. In the multivariate analysis for predicting the recurrence, repeated episode of ipsilateral pneumothorax was the significant risk factor (p = 0.0032).Conclusions: Predicting factors for persistent air leak after initial treatment were recurrence of ipsilateral pneumothorax, high degree of lung collapse, and radiological evidence of bullae. The predictive factor for recurrence after the last treatment was recurrence of ipsilateral pneumothorax. Selection of either observational or interventional approach at initial management did not affect the outcomes evaluated. Therefore, because of treatment invasiveness, observation is recommended to be attempted first in cases sans risk factors.Trial Registration: retrospectively registeredDate of IRB approval: May 28, 2018Number of IRB approval: 2017320
A prospective study of autologous ?blood patch? pleurodesis for persistent air leak after pulmonary resection
