{"title":"Journal club","authors":"Zin Nge Nge Sein","doi":"10.1136/thorax-2024-222131","DOIUrl":null,"url":null,"abstract":"Treatment recommendations for primary spontaneous pneumothorax (PSP) have changed significantly in recent years. The latest guideline by the British Thoracic Society (BTS) has shifted towards ambulatory and conservative management, following the publication of two robust randomised controlled trials (RCTs). Keijzers and colleagues have published a further post-hoc analysis from one of these RCTs, demonstrating that conservative management can safely treat a large primary spontaneous pneumothorax (European Respiratory Journal, 2024; DOI: 10.1183/13993003.00429–2024). This study used the Collins method to determine the size of the pneumothorax. Patients with a sum of interpleural distance>16 cm, equating to≥80% collapse, were defined as having large/complete collapse, and patients with an interpleural distance of 6–16 cm, equating to 32–80% as having medium (<80%) collapse. The primary outcome for conservative vs intervention (radiographic resolution at 8 weeks) was 71% vs 95% in large/complete, and 87% vs 93% in medical-sized pneumothorax (OR 1.8 vs 4.5, P-interaction: 0.10). Adverse events were higher with intervention (41/154) than with conservative (13/162) management, but where not statistically significantly different based on pneumothorax size. This study showed that most patients with a large/complete pneumothorax allocated to conservative management recovered symptomatically and radiographically with shorter hospital length of stay (0.8 …","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"36 1","pages":""},"PeriodicalIF":9.0000,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Thorax","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1136/thorax-2024-222131","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"RESPIRATORY SYSTEM","Score":null,"Total":0}
引用次数: 0
Abstract
Treatment recommendations for primary spontaneous pneumothorax (PSP) have changed significantly in recent years. The latest guideline by the British Thoracic Society (BTS) has shifted towards ambulatory and conservative management, following the publication of two robust randomised controlled trials (RCTs). Keijzers and colleagues have published a further post-hoc analysis from one of these RCTs, demonstrating that conservative management can safely treat a large primary spontaneous pneumothorax (European Respiratory Journal, 2024; DOI: 10.1183/13993003.00429–2024). This study used the Collins method to determine the size of the pneumothorax. Patients with a sum of interpleural distance>16 cm, equating to≥80% collapse, were defined as having large/complete collapse, and patients with an interpleural distance of 6–16 cm, equating to 32–80% as having medium (<80%) collapse. The primary outcome for conservative vs intervention (radiographic resolution at 8 weeks) was 71% vs 95% in large/complete, and 87% vs 93% in medical-sized pneumothorax (OR 1.8 vs 4.5, P-interaction: 0.10). Adverse events were higher with intervention (41/154) than with conservative (13/162) management, but where not statistically significantly different based on pneumothorax size. This study showed that most patients with a large/complete pneumothorax allocated to conservative management recovered symptomatically and radiographically with shorter hospital length of stay (0.8 …
期刊介绍:
Thorax stands as one of the premier respiratory medicine journals globally, featuring clinical and experimental research articles spanning respiratory medicine, pediatrics, immunology, pharmacology, pathology, and surgery. The journal's mission is to publish noteworthy advancements in scientific understanding that are poised to influence clinical practice significantly. This encompasses articles delving into basic and translational mechanisms applicable to clinical material, covering areas such as cell and molecular biology, genetics, epidemiology, and immunology.