Volume 10 Supplement 1
Can we send patients with small pneumothorax post drain removal home?
© Singh et al. 2015
Published: 16 December 2015
Pneumothorax can be a complication following chest drain removal. In thoracic surgery, access to the pleural cavity involves a pleurotomy. A chest drain is inserted to allow re-expansion of the lungs post-pleurotomy. This also prevents a tension pneumothorax. Some patients have a residual pneumothorax post-chest drain removal noted on chest radiography. Rates of pneumothorax post chest drain removal vary with figures quoted at 9.3-13.6%. The majority of these are barely perceptible or small (<1 cm from pleural line to the apex of the hemithorax). Is it safe to discharge these patients home?
To assess if it is safe to send patients with small pneumothorax home post chest drain removal
A retrospective observational study was done at our unit over a 6-month period. All patients had chest drains postoperatively and were discharged if there were no air leaks and the patients were stable. A repeat CXR was obtained during routine follow up in 6 weeks' time. Patients with pneumonectomies and permanent thoracostomies were excluded from the study.
There were 158 patients in the study. The mean age of the patients was 59.7 years (SD: 16.6). All patients were asymptomatic at the time of discharge and none required further intervention in other hospitals with regards to their pneumothorax. There were 29 (18.4%) patients who were discharged with small residual pneumothorax (<1 rib space) visible on CXR. At 6 weeks of follow up, 7 (4.4%) patients had visible pneumothorax on their CXR with no radiological or symptomatic worsening.
This study found that it was safe to discharge asymptomatic patients with a small pneumothorax provided they are haemodynamically stable. Our study shows that 76% of these patients will have no residual pneumothorax in 6 weeks' time and the remaining 24% will continue to be asymptomatic with no radiological worsening of their pneumothorax.
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