Sunday, 24 November 2013

Pneumothorax Treatments In conventional medicine perspective

The pleura is a thin tissue covered by a layer of cells (mesothelial cells) that surrounds the lungs and lines the inside of the chest wall.
A. Pneumothorax is defined as a condition of collection of air within the pleural cavity, from either the outside or from the lung of which affect the lung breathing.
G. Treatments
G.1. In conventional medicine perspective

A. Nonsurgical treatments
1. Obsercation
In most case, if the only a small portion of your lung is collapsed, the disease may be monitored with a series of X ray. Treatments only are necessary if the disease get worse. According to the study of St. Joseph’s Hospital & Medical Center of Sixteen trauma centers identified 588 OPTXs in 569 blunt trauma patients. One hundred twenty-one patients (21%) underwent immediate tube thoracostomy and 448 (79%), most blunt trauma patients with OPTX can be carefully monitored without tube thoracostomy; however, OPTX progression and respiratory distress are independently associated with observation failure(50).
2. Chest drain
In some cases, chest draining may be necessary, but adequate training for the insertion of chest drains in a trauma setting reduces the occurrence of procedure-related complications.According to the study by the Isala klinieken, locatie Sophia, afd. Heelkunde, Zwolle, for drainage of a traumatic pneumo- or haemothorax a large drain (28-36 French) is advised. The preferential insertion site is the 5th intercostal space in the midaxillary line. Drainage systems consist of a collection bottle, water seal and a suction control. Suction applied at 15-20 cm H2O is recommended for adequate drainage. Conversion to thoracotomy is determined by the drain production. Occult air leaks before removal of the drain can be detected by a temporary water seal or by clamping the drain followed by a chest X-ray(51).
3. Manual aspiration
In the study of 56 patients with baseline characteristics were similar, found that immediate success rates were 68.0% for Manual aspiration (MA) versus 80.6% for tube thoracostomy (TT) (p = 0.28). Two week success rates were 100% in both groups. There was a significant difference in hospital stay in favour of MA: 2.4 ± 2.6 versus 4.4 ± 3.3 days (p = 0.02). One year recurrence rates in MA were lower than in TT, although not statistically significant (4.0% and 12.9% p = 0.37). Predictors of immediate success were traumatic PTX and female sex. One patient died during follow-up due to heart failure. The study concluded that MA is simple, safe, cheap, minimal invasive in uncomplicated PSP/traumatic PTX with similar success and recurrence rates and a shorter hospital stay in comparison to TT and therefore the treatment of choice(52).
B. Surgery
1. Sealant
Pulmonary air leaks are common complications of lung resection and result in prolonged hospital stays and increased costs. In the study to investigate whether, compared with standard care, the use of a synthetic polyethylene glycol matrix (CoSeal®) could reduce air leaks detected by means of a digital chest drain system (DigiVent™), in patients undergoing lung resection (sutures and/or staples alone), showed that The use of CoSeal® may decrease the occurrence and severity of postoperative air leaks after lung resection and is associated with shorter hospital stay(53).
2. Thoracoscopy
In the study to review our experience of video-assisted thoracoscopic apical pleurectomy and to evaluate whether suction or water seal is superior in the postoperative treatment of primary spontaneous pneumothorax, indicated that Video-assisted thoracoscopic apical pleurectomy is effective and safe for treating primary spontaneous pneumothorax. Placing chest tubes on water seal after a brief period of suction shortens the duration of chest tube placement and hence the hospital stay(54)
2. Pleurodesis
is a surgical procedure in removing the entire pleural space and attaches the lung to the chest wall, permanently. In the study to compare the efficacy and safety between apical pleurectomy and pleural abrasion with minocycline in primary spontaneous pneumothorax (PSP) with high recurrence risk, showed that Pleural abrasion with minocycline pleurodesis is as effective as apical pleurectomy and either technique is appropriate for treating PSP patients with high recurrence risk. This trial was registered at (ID: NCT00270751)(55).

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