|The clinician's perspective on pneumothorax management.|
|PMID: 9315819 Owner: NLM Status: MEDLINE|
|OBJECTIVE: We sought to determine the current practice habits among clinicians treating spontaneous pneumothorax and bronchopleural fistula. METHODS: Practice habits were determined by a randomized postal survey of 3,000 American College of Chest Physicians members. Group comparisons are performed by chi2 analysis with p<0.05 being significant. RESULTS: Four hundred nine respondents (13.6%) included 176 practicing pulmonologists (43.0%), 67 academic pulmonologists (16.4%), 102 thoracic surgeons (25.0%), and 64 others (15.6%). More than 50% of respondents treat a first small primary spontaneous pneumothorax (PSP) by simple observation, a first small secondary spontaneous pneumothorax (SSP) by chest tube, persistent air leak in both PSP and SSP with chest tube+video-assisted thoracoscopy, and use a 20 to 24F chest tube in mechanically ventilated ARDS-related tension pneumothorax. First recurrences of PSP and SSP were treated by a variety of interventions that included simple observation (PSP=14%, SSP=4%), chest tube (22%/17%), chest tube+sclerosis (20%/16%), chest tube+video-assisted thoracoscopy (36%/48%), and chest tube+thoracotomy (5%/12%). The most popular sclerosing agents are doxycycline (48%), talc slurry (24%), and talc poudrage (19%). More than 75% of physicians intervened in a persistent air leak between 5 and 10 days. Chest tubes are initially placed to suction by 48% of respondents in PSP and removed >24 h after air leak ceases in 79%. Chest tube clamping prior to removal is employed by 67% of respondents. Significant differences exist between thoracic surgeons and pulmonologists with surgeons placing more chest tubes for first-time PSP and performing chest tube+video-assisted thoracoscopy for first recurrences of PSP more often than pulmonologists. Thoracic surgeons seldom use sclerosis in spontaneous pneumothorax compared to pulmonologists. CONCLUSIONS: Marked practice variation exists in clinicians' approaches to the management of spontaneous pneumothorax and bronchopleural fistulas that is partially explained by differences between pulmonologists and thoracic surgeons. A national consensus statement is needed to guide randomized studies in pneumothorax management.|
|M H Baumann; C Strange|
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|Type: Comparative Study; Journal Article; Research Support, Non-U.S. Gov't|
|Title: Chest Volume: 112 ISSN: 0012-3692 ISO Abbreviation: Chest Publication Date: 1997 Sep|
|Created Date: 1997-10-22 Completed Date: 1997-10-22 Revised Date: 2008-11-21|
Medline Journal Info:
|Nlm Unique ID: 0231335 Medline TA: Chest Country: UNITED STATES|
|Languages: eng Pagination: 822-8 Citation Subset: AIM; IM|
|Division of Pulmonary and Critical Care Medicine, University of Mississippi Medical Center, Jackson 39216-4505, USA.|
|APA/MLA Format Download EndNote Download BibTex|
Bronchial Fistula / therapy*
Doxycycline / therapeutic use
Fistula / therapy*
Guidelines as Topic
Physician's Practice Patterns*
Pleural Diseases / therapy*
Pneumothorax / therapy*
Randomized Controlled Trials as Topic
Respiratory Distress Syndrome, Adult / complications
Talc / therapeutic use
|0/Anti-Bacterial Agents; 0/Powders; 14807-96-6/Talc; 564-25-0/Doxycycline|
Chest. 1998 May;113(5):1423-5
Chest. 2001 Apr;119(4):1292-3 [PMID: 11296211 ]
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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