Simple Aspiration versus Drainage for Complete Pneumothorax: A Randomized Noninferiority Trial

Area of Science:

• Pulmonology
• Thoracic Surgery
• Critical Care Medicine

Background:

• Management of primary spontaneous pneumothorax (PSP) is debated.
• First-line treatment choices impact patient outcomes and recurrence rates.

Purpose of the Study:

• To compare the noninferiority of simple aspiration versus chest tube drainage for lung expansion in complete PSP.
• To evaluate treatment tolerance, adverse events, and recurrence rates.

Main Methods:

• Prospective, open-label, randomized noninferiority trial.
• Adults (18-50 years) with complete PSP received simple aspiration (n=200) or chest tube drainage (n=202).
• Primary outcome: pulmonary expansion at 24 hours; secondary outcomes: tolerance, adverse events, recurrence within 1 year.

Main Results:

• Treatment failure: 29% aspiration vs. 18% chest tube drainage (difference 0.113).
• Aspiration group reported less pain and fewer device-related issues.
• Pneumothorax recurrence: 20% aspiration vs. 27% chest tube drainage.

Conclusions:

• Simple aspiration as first-line treatment for complete PSP has a higher failure rate than chest tube drainage.
• Simple aspiration is better tolerated, with fewer adverse events and less pain.
• Chest tube drainage demonstrated a higher failure rate but potentially lower recurrence in this study.