Ambulatory care did not shorten length of stay for secondary spontaneous pneumothorax

There was no difference in hospital length of stay among patients with secondary spontaneous pneumothorax who received ambulatory care with a flutter valve or standard care, according to results published in the European Respiratory Journal.

“There are no published prospective studies describing use of flutter valves in patients with secondary spontaneous pneumothorax,” Steven P. Walker, MD, clinical research fellow in the Academic Respiratory Unit at the University of Bristol School of Clinical Sciences at Southmead Hospital, Westbury-on-Trym, U.K., and colleagues wrote. “Pooled results from retrospective studies suggest that flutter valves may reduce hospital length of stay in this patient cohort.”

The open-label, randomized controlled trial included 41 patients with secondary spontaneous pneumothorax from March 2017 to March 2020. Patients were randomly assigned to ambulatory care with flutter valve (n = 21; mean age, 63.4 years; 67% men) or standard care with a chest tube attached to an underwater seal (n = 20; mean age, 68.1 years; 85% men). Type of flutter valve used was based on whether a patient already had a chest tube in place at the time of randomization. In the ambulatory care group, 13 patients were managed with the Pleural Vent (Rocket Medical PLC) and eight were managed with the Atrium Pneumostat valve (Atrium Medical).

The primary outcome was hospital length of stay. Researchers observed no difference in length of stay during the first 30 days: median length of stay was 6 days in the ambulatory care group and 6 days in the standard care group (P = .77).

The rate of early treatment failure was higher among patients with a pleural vent compared with patients who received standard care (46% vs. 15%; P = .11). Patients managed with the Atrium Pneumostat valve had no early treatment failures (median length of stay, 1.5 days).

Results also showed early and sustained improvements in breathlessness, chest pain and quality of life in both groups.

“In conclusion, there was no difference on length of stay between patients managed with ambulatory care compared to chest drain attached to underwater seal. This may be related to high rates of treatment failure with the pleural vent and a shorter length of stay in the standard arm than previously cited,” the researchers wrote. “We do not advise use of pleural vent in patients with secondary spontaneous pneumothorax, and the encouraging results with pleural vent in primary spontaneous pneumothorax are not translatable to this population. Our study has, however, shown early supportive evidence of safety in the attachment of an Atrium Pneumostat to an existing chest drain to ambulate patients with secondary spontaneous pneumothorax. A dedicated trial using this device is now warranted.”