Letter to the Editor
Use of Thoracic Ultrasound in the Detection of Pneumothorax Resolution after Drainage
Uso de la ecografía torácica en la comprobación de la resolución del neumotórax tras drenaje
Daniel Coutinho
, Maria João Oliveira, Carla Ribeiro
Corresponding author
Pulmonology Department, Centro Hospitalar de Vila Nova de Gaia e Espinho, Vila Nova de Gaia, Portugal
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This purpose of this study was to evaluate the effectiveness of US in detecting absence of residual pneumothorax before chest tube removal in comparison with CR.</p><p id="par0010" class="elsevierStylePara elsevierViewall">All patients with pneumothorax requiring drainage admitted to our pulmonology department between April 2014 and October 2015 were consecutively included. The absence of visualization of the pleural line on US for any clinical reason was an exclusion criterion. The primary endpoint was the number of residual pneumothoraces correctly diagnosed by US. No patient was excluded from our study.</p><p id="par0015" class="elsevierStylePara elsevierViewall">US and CR were performed consecutively after bubbling had stopped. In the absence of residual pneumothorax on both US and CR the chest drain was clamped for 24<span class="elsevierStyleHsp" style=""></span>h, then removed and the patient discharged. US was performed by a single chest physician using a 5–13<span class="elsevierStyleHsp" style=""></span>MHz linear probe with the patient erect. US diagnosis of residual pneumothorax relied on the presence of any of these signs: lung point or abolition of lung sliding; lung pulse or B-lines in B-mode; and absence of seashore sign in M-mode. CR was performed with patient erect and interpreted by the physician in charge of the patient.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Sixteen male patients with unilateral pneumothorax were included (median age, 29 years). Pneumothorax cause was as follows: primary spontaneous (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>12), secondary to pulmonary emphysema (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>2), and iatrogenic (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>2). No residual pneumothorax was diagnosed by US or CR. Thus, chest drains were successfully clamped and removed in all patients, with no pneumothorax recurrence.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Our study showed that US is at least as good as CR in detecting residual pneumothoraces before chest drain removal in a pulmonology yard setting. A previous study<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> has showed that US was better than erect CR for pneumothorax follow-up after drainage. This suggests that US might have an important role in pneumothorax management. In reality, US presents some advantages in this matter, such as greater sensitivity, bedside availability, and it has a fast learning curve.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Because of a predominant ICU/trauma setting of previous studies,<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1,3</span></a> the vast majority of published evidence reports to a diagnostic accuracy comparison between supine US and CR. This favours the relevance of our study, which states the usefulness of US in the follow-up of pneumothoraces in a daily practice of a pulmonology yard setting.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Although obviously limited by our sample size, our study showed that US has a good performance in the detection of pneumothorax resolution after drainage.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Authorship</span><p id="par0040" class="elsevierStylePara elsevierViewall">Daniel Coutinho, Maria João Oliveira and Carla Ribeiro conceived the project idea and collected the data. Carla Ribeiro performed the imaging examination. Daniel Coutinho conducted the analyses. All authors interpreted and discussed the results. All authors wrote the manuscript. All authors have read and approved the final version.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Authorship" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Coutinho D, Oliveira MJ, Ribeiro C. Uso de la ecografía torácica en la comprobación de la resolución del neumotórax tras drenaje. Arch Bronconeumol. 2017;53:288.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Traumatic pneumothorax detection with thoracic US: Correlation with chest radiography and CT-initial experience" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "K. Rowan" 1 => "A. Kirkpatrick" 2 => "D. Liu" 3 => "K. Forkheim" 4 => "J. Mayo" 5 => "S. 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Zhang" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1378/chest.10-2946" "Revista" => array:6 [ "tituloSerie" => "Chest" "fecha" => "2011" "volumen" => "140" "paginaInicial" => "859" "paginaFinal" => "866" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21546439" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0045" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Management of spontaneous pneumothorax. An American College of Chest Physicians Delphi Consensus statement" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.H. Baumann" 1 => "C. Strange" 2 => "J.E. Heffner" 3 => "R. Light" 4 => "T.J. Kirby" 5 => "J. Klein" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Chest" "fecha" => "2001" "volumen" => "119" "paginaInicial" => "590" "paginaFinal" => "602" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11171742" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0050" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Management of spontaneous pneumothorax: British Thoracic Society pleural disease guideline 2010" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A. MacDuff" 1 => "A. Arnold" 2 => "J. Harvey" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/thx.2010.136986" "Revista" => array:7 [ "tituloSerie" => "Thorax" "fecha" => "2010" "volumen" => "65" "numero" => "Suppl. 2" "paginaInicial" => "ii18" "paginaFinal" => "ii31" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20696690" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15792129/0000005300000005/v1_201704280925/S1579212917300198/v1_201704280925/en/main.assets" "Apartado" => array:4 [ "identificador" => "45358" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15792129/0000005300000005/v1_201704280925/S1579212917300198/v1_201704280925/en/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212917300198?idApp=UINPBA00003Z" ]
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| 2017 December | 42 | 11 | 53 |
| 2017 November | 26 | 7 | 33 |
| 2017 October | 34 | 16 | 50 |
| 2017 September | 28 | 12 | 40 |
| 2017 August | 29 | 15 | 44 |
| 2017 May | 0 | 2 | 2 |
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