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Three Part Question

In [a patient with a primary spontaneous pneumothorax] is [management in the ambulatory setting with a pleural vent] associated with [improved patient centered outcomes]?

Clinical Scenario

A 25 year old non-smoker presents with a right sided spontaneous pneumothorax. He is breathless at rest with normal oxygen saturations on air and does not want to come into hospital for treatment.

Search Strategy

PubMed search 2010 – October 2010
[ambulatory pneumothorax] AND [randomised trial] LIMIT to human and english language

Search Outcome

6 papers of which 5 not relevant to the problem and 1 relevant

Relevant Paper(s)

Author, date and country	Patient group	Study type (level of evidence)	Outcomes	Key results	Study Weaknesses
Hallfax R et al 2020 United Kingdom	236 patients with primary spontaneous pneumothorax. 117 were in ambulatory care arm and assigned to be mananged with the pleural vent in an outpatient setting. 119 were in the standard care arm and received either needle aspiration and/or chest drain insertion.	Open-label, randomised controlled trial	Total hospital stay	0 in ambulatory care arm, 4 in standard care arm (p <0·0001)	Not all eligible patients were recruited as they presented out of normal working hours posing a potential recruitment bias. Not all patients in the standard care arm had pleural aspiration as initial management, which could have introduced bias towards the ambulatory arm. Serious adverse events were more common in the ambulatory care arm.
			Patient requiring another procedure	24 in ambulatory care arm, 42 in standard care arm (p <0·0075)
			Mean pain and breathlessness VAS scores	Similar in both groups at days 1-4
			Serious adverse events	14 in ambulatory care arm, 0 in standard care arm (p <0·0001)

Comment(s)

Ambulatory management of primary spontaneous pneumothorax with a pleural vent, which is the device used in the trial described, reduces the duration of hospitalisation but there is an increase in adverse events. Hence, for patients with primary spontaneous pneumothorax who require intervention, ambualtory devices is feasible. Safety nets and local protocols must be in place.

Clinical Bottom Line

Ambulatory pneumothorax in primary spontaneous pneumothorax is feasible.

References

1. Rob J Hallifax et al Ambulatory management of primary spontaneous pneumothorax: an open-label, randomised controlled trial The Lancet 2020 Jul 4;396(10243):39-49