ALERT!

This site is not optimized for Internet Explorer 8 (or older).

Please upgrade to a newer version of Internet Explorer or use an alternate browser such as Chrome or Firefox.

Result Summary for Survey: Management of Initial Spontaneous Pneumothorax

Wednesday, June 9, 2010

By

 

The survey on management of initial spontaneous pneumothorax provided some interesting results.  Most surgeons manage such patients with a small bore catheter or chest tube, and rarely utilize observation or aspiration.  Despite randomized studies demonstrating the utility of drainage and sclerosis in reducing the risk of recurrent pneumothorax, few surgeons perform sclerosis as part of nonoperative therapy for these patients.  Most surgeons responding to the survey indicated they would wait a week before determining that chest tube drainage had failed.  A surprisingly small number of respondents use talc or other agent to perform sclerosis as part of an operation for pneumothorax. Most surgeons preferred mechanical abrasion or pleurectomy, in spite of experimental studies that demonstrate that a sclerosing agent is more effective than mechanical abrasion for this purpose.

What is your preferred initial therapy for this patient?
Response
Percent
Response
Count
 a. Observation with oxygen therapy  5.9%   7 
 b. Aspiration  7.6%   9 
 c. Thoracic vent or other small bore catheter connected to a valve apparatusd.  22.7%   27 
 d. Chest tube placement with suction or water seal  63.9%  76 
answered question  119 
skipped question  0 
What role does drainage and non-operative chemical pleural sclerosis play in the management of this patient?
Response
Percent
Response
Count
 a. I never sclerose such patients through a drainage tube  84.9%  101 
 b. Sclerosis is best used in a patient whose air leak stops within a day or two  2.5%   3 
 c. Sclerosis is best used in a patient whose air leak is slow to resolve  7.6%   9 
 d. I use sclerosis routinely in the management of such patients.  5.0%   6 
answered question  119 
skipped question  0 
When should surgical intervention be considered for such patients?
Response
Percent
Response
Count
 a. If the air leak or pneumothorax fails to resolve after two or three days  37.8%   45 
 b. If the air leak or pneumothorax fails to resolve after a week  53.8%  64 
 c. Surgical intervention should be a routine part of the initial management of such patients.  8.4%   10 
answered question  119 
skipped question  0 
What approach do you use for surgical management of such patients?
Response
Percent
Response
Count
 a. VATS with small ports only  79.0%  94 
 b. VATS with an accessory incision  9.2%   11 
 c. Minithoracotomy (anterior, lateral, or axillary)  10.1%   12 
 d. Standard thoracotomy  1.7%   2 
answered question  119 
skipped question  0 
If a pleural procedure is included as part of your standard operation, what procedure do you use?
Response
Percent
Response
Count
 a. Mechanical abrasion  47.9%  57 
 b. Pleurectomy  39.5%   47 
 c. Talc or other chemical pleurodesis  11.8%   14 
 d. Pleural tent  0.8%   1 
answered question  119 
skipped question  0 
Which specialty initially manages patients with primary spontaneous pneumothorax at your institution?
Response
Percent
Response
Count
 a. Emergency medicine  22.0%   26 
 b. Pulmonary medicine  19.5%   23 
 c. General surgery  5.9%   7 
 d. Cardiothoracic surgery  52.5%  62 
answered question  118 
skipped question  1 
In what region is your surgical practice based?
Response
Percent
Response
Count
 a. North America  47.9%  57 
 b. Europe  36.1%   43 
 c. South America  4.2%   5 
 d. Asia  9.2%   11 
 e. Africa  2.5%   3 
answered question  119 
skipped question  0 

 

Add comment

Log in or register to post comments