Simple aspiration versus intercostal tube drainage for primary spontaneous pneumothorax in adults

Kristin V Carson‐Chahhoud; Abel Wakai; Joep EM van Agteren; Brian J Smith; Grainne McCabe; Malcolm P Brinn; Ronan O'Sullivan

doi:10.1002/14651858.CD004479.pub3

Cochrane Database of Systematic Reviews

Aspiración simple versus drenaje con tubo intercostal para el neumotórax espontáneo primario en adultos

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DOI:

https://doi.org/10.1002/14651858.CD004479.pub3 Copiar DOI

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Cochrane Database of Systematic Reviews

Versión publicada:

07 septiembre 2017see what's new

Tipo:

Intervention

Etapa:

Review

Grupo Editorial Cochrane:

Grupo Cochrane de Atención crítica y de emergencia

Copyright:

Copyright © 2018 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

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Autores

Kristin V Carson‐Chahhoud

Correspondencia a: School of Health Sciences, The University of South Australia, Adelaide, Australia

[email protected]
Abel Wakai

Emergency Care Research Unit (ECRU), Division of Population Health Sciences (PHS), Royal College of Surgeons in Ireland (RCSI), Dublin 2, Ireland
Joep EM van Agteren

College of Medicine and Public Health, Flinders University, Adelaide, Australia
Brian J Smith

Respiratory Medicine Unit, The Queen Elizabeth Hospital, Central Adelaide Local Health Network, Adelaide, Australia
Grainne McCabe

Mercer Library, Royal College of Surgeons in Ireland, Dublin, Ireland
Malcolm P Brinn

Habit Research Group, School of Public Health, The University of Queensland, Brisbane, Australia
Ronan O'Sullivan

Cork University Hospital, Cork, Ireland

National Children's Research Centre, Our Lady's Children's Hospital Crumlin, Dublin, Ireland

Contributions of authors

Kristin Carson‐Chahhoud ‐ updated the protocol, reviewed the literature, identified studies for inclusion, extracted data, entered and analysed data, completed editorial amendments, and updated the text of the manuscript.

Joseph van Agteren ‐ updated the protocol, reviewed the literature, identified studies for inclusion, extracted data, entered and analysed data, and updated the text of the manuscript.

Abel Wakai ‐ authored the original review, updated the text of the manuscript, and supervised the update.

Brian Smith ‐ updated the text of the manuscript and supervised the latest update.

Grainne McCabe ‐ authored the original review and identified studies for inclusion in the update.

Malcolm Brinn ‐ updated search and identified studies for inclusion.

Ronan O'Sullivan ‐ authored the original review.

Sources of support

Internal sources

Department of Emergency Medicine, St. Vincent's University Hospital, Dublin, Ireland.

External sources

Higher Specialist Training Scheme in Emergency Medicine, Ireland.

Declarations of interest

Kristin Carson‐Chahhoud: no conflicts of interest to declare.

Abel Wakai: no conflicts of interest to declare.

Joseph van Agteren: no conflicts of interest to declare.

Brian Smith: no conflicts of interest to declare.

Grainne McCabe: no conflicts of interest to declare.

Malcolm Brinn: no conflicts of interest to declare.

Ronan O'Sullivan: no conflicts of interest to declare.

Acknowledgements

We wish to acknowledge and thank Frédérique Noble for translating the Desmettre 2010 publication into English. For their tireless efforts, we wish to thank all staff and editors of the Cochrane Anaesthesia, Crticial and Emergency Care Group, in particular Jane Cracknell, who aided review completion and provided valuable feedback and suggestions.

We would like to thank Harald Herkner (Content Editor); Jing Xie (Sophia) (Statistical Editor); Nick Maskell and Teresa Williams (Peer Reviewers); Janne Vendt (Information Specialist); and Brian Stafford (Consumer Referee) for help and editorial advice provided during preparation of this updated systematic review.

Version history

Published

Title

Stage

Authors

Version

2017 Sep 07

Simple aspiration versus intercostal tube drainage for primary spontaneous pneumothorax in adults

Review

Kristin V Carson‐Chahhoud, Abel Wakai, Joep EM van Agteren, Brian J Smith, Grainne McCabe, Malcolm P Brinn, Ronan O'Sullivan

https://doi.org/10.1002/14651858.CD004479.pub3

2007 Jan 24

Simple aspiration versus intercostal tube drainage for primary spontaneous pneumothorax in adults

Review

Abel Wakai, Ronan O'Sullivan, Grainne McCabe

https://doi.org/10.1002/14651858.CD004479.pub2

2003 Oct 20

Simple aspiration versus intercostal tube drainage for primary spontaneous pneumothorax in adults

Protocol

Abel Wakai, Ronan G. O'Sullivan, Conor Deasy, Grainne McCabe

https://doi.org/10.1002/14651858.CD004479

Differences between protocol and review

We have changed the review author line since the protocol (Wakai 2003) and the original review (Wakai 2007) were prepared, by adding Kristin Carson‐Chahhoud, Joseph van Agteren, Malcolm Brinn, and Brian Smith.
We used the GRADE approach to assess the quality of the evidence in this update.
We reduced the number of secondary outcomes to adhere to Cochrane recommendations to include as small a total number of outcomes as possible, while keeping them clinically relevant (went from 13 to 7 secondary outcomes).
We incorporated a 'Summary of findings' table into the review.
We changed the analysis method from a fixed‐effect to a random‐effects model for all outcomes.
We included in the review studies investigating participants with a recurrent pneumothorax and conducted a sensitivity analysis to examine potential biases.

Keywords

MeSH

Medical Subject Headings (MeSH) Keywords

Medical Subject Headings Check Words

Humans;

PICO

Population

Intervention

Comparison

Outcome

El uso y la enseñanza del modelo PICO están muy extendidos en el ámbito de la atención sanitaria basada en la evidencia para formular preguntas y estrategias de búsqueda y para caracterizar estudios o metanálisis clínicos. PICO son las siglas en inglés de cuatro posibles componentes de una pregunta de investigación: paciente, población o problema; intervención; comparación; desenlace (outcome).

Para saber más sobre el uso del modelo PICO, puede consultar el Manual Cochrane.

Figure 1

Study flow diagram.

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Figure 2

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

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Figure 3

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

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Figure 4

Forest plot of comparison: 1 Simple aspiration versus intercostal tube drainage, outcome: 1.1 Immediate success rate of procedure as defined by study authors.

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Analysis 1.1

Comparison 1 Simple aspiration versus intercostal tube drainage, Outcome 1 Immediate success rate of procedure as defined by study authors.

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Analysis 1.2

Comparison 1 Simple aspiration versus intercostal tube drainage, Outcome 2 Early failure rate of procedure (incomplete lung expansion after the procedure).

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Analysis 1.3

Comparison 1 Simple aspiration versus intercostal tube drainage, Outcome 3 One‐year success rate (number of participants with no recurrence of pneumothorax at 1 year).

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Analysis 1.4

Comparison 1 Simple aspiration versus intercostal tube drainage, Outcome 4 Hospitalization rate (number of participants hospitalized).

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Analysis 1.5

Comparison 1 Simple aspiration versus intercostal tube drainage, Outcome 5 Duration of hospital stay in days.

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Analysis 2.1

Comparison 2 Sensitivity analysis for risk of bias, Outcome 1 Hospitalization (number of participants hospitalized).

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Analysis 3.1

Comparison 3 Sensitivity analysis following visual inspection of data, Outcome 1 Hospitalization (number of participants hospitalized).

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Analysis 4.1

Comparison 4 Sensitivity analysis for studies with recurrent pneumothorax, Outcome 1 Immediate success rate of procedure as defined by study authors.

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Analysis 4.2

Comparison 4 Sensitivity analysis for studies with recurrent pneumothorax, Outcome 2 Early failure rate of procedure (incomplete lung expansion after the procedure).

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Analysis 4.3

Comparison 4 Sensitivity analysis for studies with recurrent pneumothorax, Outcome 3 One‐year success rate (number of participants with no recurrence of pneumothorax at 1 year).

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Analysis 4.4

Comparison 4 Sensitivity analysis for studies with recurrent pneumothorax, Outcome 4 Duration of hospital stay in days.

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Summary of findings for the main comparison. Simple aspiration compared with intercostal tube drainage for primary spontaneous pneumothorax

Simple aspiration compared with intercostal tube drainage for primary spontaneous pneumothorax
Patient or population: adults with primary spontaneous pneumothorax Settings: university teaching hospitals, tertiary care hospitals, and general hospitals Intervention: simple aspiration Comparison: intercostal tube drainage
Outcomes	Illustrative comparative risks (95% CI)		Relative effect (95% CI)	No. of participants (studies)	Quality of the evidence (GRADE)	Comments
Outcomes	Intercostal tube drainage	Simple aspiration	Relative effect (95% CI)	No. of participants (studies)	Quality of the evidence (GRADE)	Comments
Immediate success rate Follow‐up: 3 days to 24 months	714 per 1000	557 per 1000 (493 to 635)	RR 0.78 (0.69 to 0.89)	435 (6 studies)	⊕⊕⊕⊝ moderate^a
One‐year success rate Follow‐up: 12 to 24 months	766 per 1000	820 per 1000 (735 to 904)	RR 1.07 (0.96 to 1.18)	318 (4 studies)	⊕⊕⊕⊝ moderate^a
Hospitalization rate Follow‐up: 3 days to 24 months	862 per 1000	517 per 1000 (215 to 1000)	RR 0.60 (0.25 to 1.47)	245 (3 studies)	⊕⊝⊝⊝ very low^a,b,c
Duration of hospital stay Follow‐up: 12 to 24 months	Mean duration of hospital stay ranged across control groups from 4.04 to 7 days.	Mean duration of hospital stay in the intervention groups was 1.66 lower (‐2.28 to ‐1.04).	—	387 (5 studies)	⊕⊕⊕⊝ moderate^a
Adverse events Follow‐up: 3 days to 24 months	Overall, fewer adverse events occurred when patients were treated by simple aspiration than by tube drainage, including lesser perceived pain and lower pain scores, reduced need for thoracoscopic pleurodesis, and fewer technical adverse events (e.g. tube blockage when treated by tube drainage).		Not estimable	245 (3 studies)	⊕⊕⊝⊝ low^a,d
Cost‐effectiveness Not reported	See comment.	See comment.	Not estimable	‐	See comment.	No studies reported cost‐effectiveness data.
Patient satisfaction Follow‐up: mean 3 days	Median patient satisfaction among those treated with intercostal tube drainage was 8 on a visual analogue scale of 1 to 10 (Interquartile range 6.25 to 9.00), and median patient satisfaction among those treated by simple aspiration was 0.5 points lower (Interquartile range 5.00 to 9.00).			48 (1 study)	⊕⊕⊝⊝ low^a,e
CI: confidence interval; RR: risk ratio
GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate.
^aResults for all outcomes downgraded one level as a result of study and/or reporting limitations, specifically, the large number of unclear or high risks of bias in the presented studies. ^bDowngraded one level as a result of significant heterogeneity (I² = 91%). ^cDowngraded one level as a result of imprecision: low numbers of events and large confidence intervals. ^dDowngraded one level as a result of inconsistency in and lack of reporting of adverse events. ^eDowngraded one level as a result of imprecision: reported by only one small study of 48 participants.

Summary of findings for the main comparison. Simple aspiration compared with intercostal tube drainage for primary spontaneous pneumothorax

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Comparison 1. Simple aspiration versus intercostal tube drainage

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Immediate success rate of procedure as defined by study authors Show forest plot	6	435	Risk Ratio (M‐H, Random, 95% CI)	0.78 [0.69, 0.89]

2 Early failure rate of procedure (incomplete lung expansion after the procedure) Show forest plot	6	427	Risk Ratio (M‐H, Random, 95% CI)	1.24 [0.91, 1.68]

3 One‐year success rate (number of participants with no recurrence of pneumothorax at 1 year) Show forest plot	4	318	Risk Ratio (M‐H, Random, 95% CI)	1.07 [0.96, 1.18]

4 Hospitalization rate (number of participants hospitalized) Show forest plot	3	245	Risk Ratio (M‐H, Random, 95% CI)	0.60 [0.25, 1.47]

5 Duration of hospital stay in days Show forest plot	5	387	Mean Difference (IV, Random, 95% CI)	‐1.66 [‐2.28, ‐1.04]

Comparison 1. Simple aspiration versus intercostal tube drainage

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Comparison 2. Sensitivity analysis for risk of bias

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Hospitalization (number of participants hospitalized) Show forest plot	3	245	Risk Ratio (M‐H, Random, 95% CI)	0.60 [0.25, 1.47]

1.1 Unclear risk of bias	1	60	Risk Ratio (M‐H, Random, 95% CI)	0.53 [0.37, 0.75]
1.2 Low risk of bias	2	185	Risk Ratio (M‐H, Random, 95% CI)	0.69 [0.10, 4.61]

Comparison 2. Sensitivity analysis for risk of bias

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Comparison 3. Sensitivity analysis following visual inspection of data

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Hospitalization (number of participants hospitalized) Show forest plot	3	245	Risk Ratio (M‐H, Random, 95% CI)	0.60 [0.25, 1.47]

1.1 All participants admitted for tube drainage	2	197	Risk Ratio (M‐H, Random, 95% CI)	0.38 [0.19, 0.76]
1.2 Not all participants admitted for tube drainage	1	48	Risk Ratio (M‐H, Random, 95% CI)	1.86 [0.89, 3.91]

Comparison 3. Sensitivity analysis following visual inspection of data

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Comparison 4. Sensitivity analysis for studies with recurrent pneumothorax

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Immediate success rate of procedure as defined by study authors Show forest plot	6	435	Risk Ratio (M‐H, Random, 95% CI)	0.78 [0.69, 0.89]

1.1 Recurrent primary spontaneous pneumothorax (PSP)	2	134	Risk Ratio (M‐H, Random, 95% CI)	0.69 [0.58, 0.82]
1.2 First episode PSP	4	301	Risk Ratio (M‐H, Random, 95% CI)	0.89 [0.75, 1.06]
2 Early failure rate of procedure (incomplete lung expansion after the procedure) Show forest plot	6	427	Risk Ratio (M‐H, Random, 95% CI)	1.24 [0.91, 1.68]

2.1 Recurrent PSP	2	126	Risk Ratio (M‐H, Random, 95% CI)	2.20 [0.11, 42.99]
2.2 First episode PSP	4	301	Risk Ratio (M‐H, Random, 95% CI)	1.28 [0.93, 1.77]
3 One‐year success rate (number of participants with no recurrence of pneumothorax at 1 year) Show forest plot	4	318	Risk Ratio (M‐H, Random, 95% CI)	1.07 [0.96, 1.18]

3.1 Recurrent PSP	1	65	Risk Ratio (M‐H, Random, 95% CI)	1.17 [0.90, 1.52]
3.2 First episode PSP	3	253	Risk Ratio (M‐H, Random, 95% CI)	1.05 [0.94, 1.17]
4 Duration of hospital stay in days Show forest plot	5	387	Mean Difference (IV, Random, 95% CI)	‐1.66 [‐2.28, ‐1.04]

4.1 Recurrent PSP	2	134	Mean Difference (IV, Random, 95% CI)	‐1.32 [‐3.31, 0.67]
4.2 First episode PSP	3	253	Mean Difference (IV, Random, 95% CI)	‐1.69 [‐2.40, ‐0.98]

Comparison 4. Sensitivity analysis for studies with recurrent pneumothorax

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Aspiración simple versus drenaje con tubo intercostal para el neumotórax espontáneo primario en adultos

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