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International Expert Consensus and Recommendations for Neonatal Pneumothorax Ultrasound Diagnosis and Ultrasound-guided Thoracentesis Procedure
Published on: March 12, 2020
Pneumothorax following thoracentesis: a systematic review and meta-analysis
Craig E Gordon1, David Feller-Kopman, Ethan M Balk
1Renal Section, Department of Medicine, Boston University Medical Center, Boston, MA 02118, USA. craig.gordon@bmc.org
Archives of Internal Medicine
|February 24, 2010
Summary
Iatrogenic pneumothorax is a common complication of thoracentesis, occurring in 6.0% of cases and often requiring chest tube insertion. Using real-time ultrasonography significantly reduces this risk, improving patient safety.
Area of Science:
- Pulmonary Medicine
- Interventional Procedures
- Medical Complications
Background:
- Pneumothorax is a known complication of thoracentesis, but factors influencing its development are not well understood.
- Understanding these risk factors is crucial for improving patient safety during thoracentesis procedures.
Purpose of the Study:
- To determine the overall rate of pneumothorax following thoracentesis.
- To identify specific risk factors associated with the development of pneumothorax after thoracentesis.
Main Methods:
- A systematic review and meta-analysis of MEDLINE-indexed studies published from January 1, 1966, to April 1, 2009.
- Inclusion criteria required studies with at least 10 patients reporting pneumothorax rates after thoracentesis.
- Data extraction by two independent investigators focused on pneumothorax rates, risk factors, and study quality.
Main Results:
- The overall pneumothorax rate across 24 studies (6605 thoracenteses) was 6.0% (95% CI, 4.6%-7.8%), with 34.1% requiring chest tube insertion.
- Real-time ultrasonography use was associated with a significantly lower risk of pneumothorax (OR, 0.3; 95% CI, 0.2-0.7).
- Therapeutic thoracentesis (OR, 2.6) and periprocedural symptoms (OR, 26.6) increased pneumothorax likelihood, while experienced operators showed a trend toward lower rates.
Conclusions:
- Iatrogenic pneumothorax is a frequent complication of thoracentesis, often necessitating chest tube intervention.
- Real-time ultrasonography is a modifiable factor that effectively reduces the incidence of pneumothorax.
- Clinical practice adjustments, particularly regarding therapeutic thoracentesis and patient selection (e.g., mechanical ventilation), can enhance patient safety.
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