Management of pneumothorax with a mini-drain in ambulatory and hospitalized patients

To test the clinical performance of a miniaturized drainage system and compare the effect on pain and mobility between the new system and a standard system. One aim was to try ambulatory treatment in patients with uncomplicated pneumothorax (35/55), another to see if patients with more severe diseases and pneumothorax could be mobilized better while in hospital.

Follow-up of 55 patients treated with the new system. Detailed analysis of a subgroup of 20 of those patients compared with 17 patients treated with a standard system.

No major complications occurred. Minor complications were haematomas and bleeding in three patients. In 12% the unit had to be replaced due to blockage by clots, obstruction of the tube, or sub-optimal performance. There were nine recurrences (16%), so patients had to have a standard drain or be referred for operation. In the subgroup of 35 patients with uncomplicated primary pneumothorax, 31 (88.5%) could be managed on an outpatient basis resulting in considerable cost reductions. Many of those patients could lead a normal life, including work during the treatment time. The new drain system was significantly less painful during activities related to sleep, hygiene, toilet visits and extraction.

The function of the mini-drain was satisfactory in the majority of cases, but cases with pleural fluid should be avoided. The recurrences were more due to the severe nature of the pulmonary leak rather than to inadequacy of the drain. The side effects mostly occurred in the first patients, so there was a learning curve. The new system should be tried in all patients presenting with an uncomplicated pneumo-thorax allowing ambulatory treatment. Patients with other diseases complicated by pneumothorax could have the new system in order not to be confined to bed. The new system has no place in patients bedridden due to other severe diseases.