Manual aspiration versus chest tube drainage in primary spontaneous pneumothorax without underlying lung diseases: a meta-analysis of randomized controlled trials

Abstract

Objectives: Although primary spontaneous pneumothorax (PSP) is an extremely frequent pathology, there is still no clear consensus on the treatment for these patients. We performed a strict meta-analysis on the effectiveness of manual aspiration (MA) compared to chest tube drainage (CTD) for the treatment of PSP.

Methods: A literature search was performed on PubMed, EMBASE and the Cochrane Library to identify randomized controlled trials comparing MA with CTD for the treatment of PSP. Independent reviewers evaluated the methodological quality of the included randomized controlled trials. Statistical heterogeneity among studies was quantitatively evaluated using the I-squared index.

Results: Five randomized controlled trials were included, and a total of 358 subjects were reported on. We found that MA was related to significantly shorter hospital stays [in days; mean difference -1.70, 95% confidence interval (CI) -2.36 to -1.04; P < 0.00001, fixed effect model] compared with CTD. However, no significant differences were found between the 2 treatments for immediate success rate (risk ratio 1.15, 95% CI 0.73-1.81; P = 0.54), 1-year recurrence rate, 1-week success rate, time of recurrence, chest surgery rate or complication rate. Subgroup analysis showed that MA can provide a significantly lower hospitalization rate than CTD with a tube size of >12 Fr or a water seal drainage system.

Conclusions: On the basis of the currently available literature, MA is advantageous in the treatment of PSP because of shorter hospital stays. The subgroup analysis also indicates that MA can provide a lower hospitalization rate than CTD with a tube size of >12 Fr or a water seal drainage system. However, there are no significant differences between the 2 interventions with respect to immediate success rate, 1-year recurrence rate, 1-week success rate, time of recurrence, chest surgery rate or complication rate.

Keywords: Chest tube drainage; Manual aspiration; Meta-analysis; Primary spontaneous pneumothorax.