Systematic review and meta-analysis of initial management of pneumothorax in adults: Intercostal tube drainage versus other invasive methods

The ideal invasive management as initial approach for pneumothorax (PTX) is still under debate. The purpose of this systematic review and meta-analysis was to examine the evidence for the effectiveness of intercostal tube drainage and other various invasive methods as the initial approach to all sub...

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Bibliographic Details
Published in:PloS one 2017-06, Vol.12 (6), p.e0178802-e0178802
Main Authors: Kim, Min Joung, Park, Incheol, Park, Joon Min, Kim, Kyung Hwan, Park, Junseok, Shin, Dong Wun
Format: Article
Language:English
Subjects:
Adults
Analysis
Bias
Biology and Life Sciences
Catheterization
Catheters
Complications
Confidence intervals
Drainage - adverse effects
Drainage - methods
Emergency medical care
Heterogeneity
Hospitals
Humans
Intervention
Intubation
Length of Stay
Medicine
Medicine and Health Sciences
Meta-analysis
Methods
Patients
Physical Sciences
Pneumothorax
Pneumothorax - therapy
Research and Analysis Methods
Studies
Surgical drains
Treatment Outcome
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Summary:The ideal invasive management as initial approach for pneumothorax (PTX) is still under debate. The purpose of this systematic review and meta-analysis was to examine the evidence for the effectiveness of intercostal tube drainage and other various invasive methods as the initial approach to all subtypes of PTX in adults. Three databases were searched from inception to May 29, 2016: MEDLINE, EMBASE, and the Cochrane CENTRAL. Randomised controlled trials that evaluated intercostal tube drainage as the control and various invasive methods as the intervention for the initial approach to PTX in adults were included. The primary outcome was the early success rate of each method, and the risk ratios (RRs) were used for an effect size measure. The secondary outcomes were recurrence rate, hospitalization rate, hospital stay, and complications. Seven studies met our inclusion criteria. Interventions were aspiration in six studies and catheterization connected to a one-way valve in one study. Meta-analyses were conducted for early success rate, recurrence rate, hospitalization rate, and hospital stay. Aspiration was inferior to intercostal tube drainage in terms of early success rate (RR = 0.82, confidence interval [CI] = 0.72 to 0.95, I2 = 0%). While aspiration and intercostal tube drainage showed no significant difference in the recurrence rate (RR = 0.84, CI = 0.57 to 1.23, I2 = 0%), aspiration had shorter hospital stay than intercostal tube drainage (mean difference = -1.73, CI = -2.33 to -1.13, I2 = 0%). Aspiration had lower hospitalization rate than intercostal tube drainage, but marked heterogeneity was present (RR = 0.38, CI = 0.19 to 0.76, I2 = 85%). Aspiration was inferior to intercostal tube drainage in terms of early resolution, but it had shorter hospital stay. The recurrence rate of aspiration and intercostal tube drainage did not differ significantly. The efficacy of catheterization connected to a one-way valve was inconclusive because of the small number of relevant studies. (Registration of study protocol: PROSPERO, CRD42016037866).
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0178802