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Osteopathic Manipulative Treatment as a Useful Adjunctive Tool for Pneumonia
Published on: May 6, 2014
Management of AIDS-related pneumothorax
G D Trachiotis1, L A Vricella, D Alyono
1Department of Surgery, George Washington University Medical Center, Washington, DC 20037, USA.
The Annals of Thoracic Surgery
|December 1, 1996
Summary
Pneumothorax in AIDS patients is complex. Converting to a Heimlich valve for persistent bronchopleural fistula can shorten hospitalization and allow earlier discharge with no apparent morbidity or mortality.
Area of Science:
- Pulmonology
- Infectious Diseases
- Critical Care Medicine
Background:
- Pneumothorax (PTX) affects 5% of patients with acquired immunodeficiency syndrome (AIDS) and Pneumocystis carinii pneumonia (PCP).
- Up to 50% of these patients may die during hospitalization.
- Current treatments for AIDS-related PTX are often complex, ineffective, and prolong hospital stays.
Purpose of the Study:
- To evaluate a therapeutic approach for earlier recovery and effective management of PTX in male patients with AIDS.
- To assess treatment strategies for 44 PTXs in 36 male patients with AIDS over 2.5 years.
- To determine if specific interventions can improve outcomes for AIDS-related PTX.
Main Methods:
- Retrospective review of 36 male patients with AIDS and 44 PTXs.
- All patients had a history of PCP and CD4+ counts <100/microL.
- Analysis of treatment effectiveness including tube thoracostomy, sclerosing therapy, thoracotomy, and Heimlich valve conversion.
Main Results:
- 27 patients with 31 PTXs were discharged; 21 PTXs resolved before discharge.
- 10 PTXs were converted from Pleurevac drainage to a Heimlich valve for persistent bronchopleural fistula, allowing discharge in <10 days.
- Heimlich valve management in 8 patients with 10 PTXs resulted in effective PTX control, no associated morbidity or mortality, and earlier discharge.
Conclusions:
- Management of AIDS-related PTX is challenging due to pulmonary destruction and systemic AIDS complications.
- Sclerosing therapy and thoracotomy have a limited role in managing these PTXs.
- Converting patients with advanced AIDS and PTX with bronchopleural fistula to a Heimlich valve facilitates outpatient management, potentially shortening hospitalization and enabling earlier discharge.
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