/ / EN
JOINT WEBSITE OF THE HONG KONG THORACIC SOCIETY AND THE CHEST DELEGATION HONG KONG AND MACAU
back to home

2011

2011 Jun - The Clinical Course and Outcome of persistent air-leak in spontaneous pneumothorax in a regional hospital in Hong Kong

Dr Jones Hau-Chung Kwok
Department of Medicine and Geriatrics, Princess Margaret Hospital


Background and Objective
Pneumothorax is a common, yet challenging disease in respiratory medicine. Spontaneous pneumothorax (SP) is the most common type of pneumothorax in Hong Kong. A portion of patients suffers from persistent air-leak despite chest drain insertion. International guidelines advocate 5-7 days arbitrarily as persistent air-leak. Managements of the situation are diversified according to different clinical situations. The aim of this study is to examine the characteristics and timing of the persistent air leak of SP in a regional hospital, and to review the treatment modalities and complications. Knowing this challenging situation of persistent airleak would facilitate treatment planning for different patients.

Methods
The study population comprised of adult > 18 years old admitted into Princess Margaret hospital over a 2-year period from January 2008 to December 2009. Medical records and Chest X ray were reviewed retrospectively.

Result:
Among the total of 291 episodes of pneumothorax, 192 episodes of spontaneous pneumothorax were examined, with further sub-analysis in 159 episodes of SP with chest drain inserted. The mean duration of air-leak was 5 days in Primary Spontaneous Pneumothorax (PSP) and 11 days in Secondary Spontaneous Pneumothorax (SSP). If 7 days was arbitrarily defined as persistent air-leak, there were 71.7% of patient resolved among PSP while only 64.0% of patient resolved among SSP. 95.5% of PSP will have the air leak ceased by 14 days; while 75.4% of SSP will have air leak ceased by 14 days. (See figure 1)
There were no significant correlation between the age (0.694, p=0.452), gender (male), (1.783, p = 0.484) smoking habit (1.343, p = 0.528) and with underlying lung disease (1.404, p = 0.516) to the time taken for the air leak to resolve by 7 days in logistic regression model analysis. The outcome modalities of the 159 episodes of SP with chest drain inserted were: 117 episodes had spontaneous resolution (73.6%); 22 episodes had resolution after surgery (13.8%); 11 episodes had resolution after medical pleurodesis (6.9%); 4 episodes resolved after endobronchial valve implantation (2.6%) and 5 episodes were recorded death (3.1%).

Figure 1: The time course of resolution of air-leak in primary and secondary pneumothorax (revised of the x-axis after day 40)

Figure 1: The time course of resolution of air-leak in primary and secondary pneumothorax (revised of the x-axis after day 40)

Conclusion
Based on the study result, we propose the date of aggressive management could be considered when there are still 50% more of the patients having air-leak, and it will be on Day 3 in PSP and Day 4 in SSP. The date of active intervention is arbitrarily proposed and is subjected to debate. The consideration should be a balance between the benefits and the drawbacks of intervention. New treatment modalities as both endobronchially and intrapleurally are evolving, and are challenging the existing guidelines of management. Therefore, a tailor-made approach and evidence-based management is necessary for each individual patient in spontaneous pneumothorax.

Top