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Marx T, Joly LM, Parmentier AL, Pretalli JB, Puyraveau M, Meurice JC, Schmidt J, Tiffet O, Ferretti G, Lauque D, Honnart D, Al Freijat F, Dubart AE, Grandpierre RG, Viallon A, Perdu D, Roy PM, El Cadi T, Bronet N, Duncan G, Cardot G, Lestavel P, Mauny F, Desmettre T. Simple Aspiration versus Drainage for Complete Pneumothorax: A Randomized Noninferiority Trial. Am J Respir Crit Care Med 2023; 207:1475-1485. [PMID: 36693146 DOI: 10.1164/rccm.202110-2409oc] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 01/24/2023] [Indexed: 01/26/2023] Open
Abstract
Rationale: Management of first episodes of primary spontaneous pneumothorax remains the subject of debate. Objectives: To determine whether first-line simple aspiration is noninferior to first-line chest tube drainage for lung expansion in patients with complete primary spontaneous pneumothorax. Methods: We conducted a prospective, open-label, randomized noninferiority trial. Adults aged 18-50 years with complete primary spontaneous pneumothorax (total separation of the lung from the chest wall), recruited at 31 French hospitals from 2009 to 2015, received simple aspiration (n = 200) or chest tube drainage (n = 202) as first-line treatment. The primary outcome was pulmonary expansion 24 hours after the procedure. Secondary outcomes were tolerance of treatment, occurrence of adverse events, and recurrence of pneumothorax within 1 year. Substantial discordance in the numerical inputs used for trial planning and the actual trial rates of the primary outcome resulted in a reevaluation of the trial analysis plan. Measurement and Main Results: Treatment failure occurred in 29% in the aspiration group and 18% in the chest tube drainage group (difference in failure rate, 0.113; 95% confidence interval [CI], 0.026-0.200). The aspiration group experienced less pain overall (mean difference, -1.4; 95% CI, -1.89, -0.91), less pain limiting breathing (frequency difference, -0.18; 95% CI, -0.27, -0.09), and less kinking of the device (frequency difference, -0.05; 95% CI, -0.09, -0.01). Recurrence of pneumothorax was 20% in this group versus 27% in the drainage group (frequency difference, -0.07; 95% CI, -0.16, +0.02). Conclusions: First-line management of complete primary spontaneous pneumothorax with simple aspiration had a higher failure rate than chest tube drainage but was better tolerated with fewer adverse events. Clinical trial registered with www.clinicaltrials.gov (NCT01008228).
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Affiliation(s)
| | - Luc-Marie Joly
- Service d'accueil des urgences, Centre hospitalier universitaire de Rouen, Rouen, France
| | | | - Jean-Baptiste Pretalli
- Centre Investigation Clinique INSERM 1431, Centre hospitalier universitaire de Besançon, Besançon, France
| | | | - Jean-Claude Meurice
- Service de pneumologie, Centre hospitalier universitaire de Poitiers, Poitiers, France
| | - Jeannot Schmidt
- Service d'accueil des urgences, Centre hospitalier universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | | | - Gilbert Ferretti
- Service de radiologie diagnostic et thérapeutique, Centre hospitalier universitaire de Grenoble, Grenoble, France
| | | | - Didier Honnart
- Service d'accueil des urgences, Centre hospitalier universitaire de Dijon, Dijon, France
| | - Faraj Al Freijat
- Service de pneumologie, Hôpital Nords Franche-Comté, Trévenans, France
| | - Alain Eric Dubart
- Service d'accueil des urgences, Centre hospitalier de Béthune, Béthune, France
| | - Romain Genre Grandpierre
- Service d'anesthésie et soins intensifs, Centre hospitalier universitaire de Nîmes, Nîmes, France
| | - Alain Viallon
- Service d'accueil des urgences, Centre hospitalier universitaire de Saint-Etienne, Saint-Etienne, France
| | - Dominique Perdu
- Service de pneumologie, Centre hospitalier universitaire de Reims, Reims, France
| | - Pierre Marie Roy
- Service d'accueil des urgences, Centre hospitalier universitaire d'Angers, Angers, France
| | - Toufiq El Cadi
- Service d'accueil des urgences, Groupe hospitalier de la Haute-Saône, Vesoul, France
| | - Nathalie Bronet
- Service d'accueil des urgences, Centre hospitalier Saint-Philibert-GHICL, Lomme, France
| | - Grégory Duncan
- Service d'accueil des urgences, Centre hospitalier Boulogne-sur-Mer, Boulogne-sur-Mer, France
| | - Gilles Cardot
- Service de chirurgie thoracique, Centre hospitalier Duchenne, Boulogne-sur-Mer, France; and
| | - Philippe Lestavel
- Service de soins intensifs, Polyclinique de Hénin-Beaumont, Hénin-Beaumont, France
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Thomas PA, Berbis J, Falcoz PE, Le Pimpec-Barthes F, Bernard A, Jougon J, Porte H, Alifano M, Dahan M, Alauzen M, Andro JF, Aubert M, Avaro JP, Azorin J, Bagan P, Bellenot F, Blin V, Boitet P, Bordigoni L, Borrelly J, Brichon PY, Cardot G, Carrie JM, Clement F, Corbi P, Debaert M, Debrueres B, Dubrez J, Ducrocq X, Dujon A, Dumont P, Fernoux P, Filaire M, Frassinetti E, Frey G, Gossot D, Grosdidier G, Guibert B, Hagry O, Jaillard S, Jarry JM, Kaczmarek D, Laborde Y, Lenot B, Levy F, Lombart L, Marcade E, Marcade JP, Marzelle J, Massard G, Mazeres F, Mensier E, Metois D, Michaud J, Paris E, Mondine P, Monteau M, Moreau JM, Mouroux J, Mugniot A, Mulsant P, Naffaa N, Neveu P, Pavy G, Peillon C, Pons F, Porte H, Regnard JF, Riquet M, Looyeh BS, Thomas P, Tiffet O, Tremblay B, Valla J, Velly JF, Wack B, Wagner JD, Woelffe D. National perioperative outcomes of pulmonary lobectomy for cancer: the influence of nutritional status. Eur J Cardiothorac Surg 2013; 45:652-9; discussion 659. [DOI: 10.1093/ejcts/ezt452] [Citation(s) in RCA: 110] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
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