Study objective: To assess conventional, large chest tube therapy in iatrogenic pneumothorax and to determine the optimal moment when to use more invasive procedures.
Design: Retrospective chart review.
Setting: Medical intensive care unit of a university hospital.
Patients: Forty-seven patients with needle-induced iatrogenic pneumothorax. Twenty-four patients had an underlying pleural or pulmonary disorder.
Interventions: After insertion of a 20- to 24-French plastic chest tube connected to an underwater seal, suction was maintained until gas egress stopped or up to 10 days in patients with a persisting gas leak.
Results: In 96 percent, a definite occlusion of the pneumothorax was achieved. In all patients without an underlying lung disorder, gas egress stopped definitely after 72 h. In the presence of an underlying lung disorder, 92 percent of the pneumothoraces were healed after 10 days of continuous suction therapy. At 72 h, only 71 percent of the latter group were healed (p < 0.05 vs patients without lung disease). No major complication of chest tube therapy occurred.
Conclusion: Conventional chest tube therapy is a safe and effective treatment for iatrogenic pneumothorax. In patients with an underlying lung disease, gas egress may last for up to 10 days. In these patients, the earlier use of a more invasive approach may be justified if the air leak persists.