OPTICC: A multicentre trial of Occult Pneumothoraces subjected to mechanical ventilation: The final report
| Autor: | Andrew W Kirkpatrick, Chad G. Ball, Neil Parry, Vincent Trottier, Thomas W. Clements, Sandro Rizoli, Derek J. Roberts, Zhengwen Jimmy Xiao, Marco Sirois |
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| Rok vydání: | 2020 |
| Předmět: |
Adult
Male medicine.medical_specialty medicine.medical_treatment 03 medical and health sciences Young Adult 0302 clinical medicine medicine Humans 030212 general & internal medicine Drainage Watchful Waiting Aged Mechanical ventilation Respiratory Distress Syndrome Respiratory distress business.industry Pneumothorax 030208 emergency & critical care medicine General Medicine Middle Aged medicine.disease Tension pneumothorax Occult Respiration Artificial Surgery Chest tube Breathing Female business |
| Zdroj: | American journal of surgery. 221(6) |
| ISSN: | 1879-1883 |
| Popis: | Introduction Patients with occult pneumothorax (OPTX) requiring positive-pressure ventilation (PPV) face uncertain risks of tension pneumothorax or chest drainage complications. Methods Adults with traumatic OPTXs requiring PPV were randomized to drainage/observation, with the primary outcome of composite “respiratory distress” (RD)). Results Seventy-five (75) patients were randomized to observation, 67 to drainage. RD occurred in 38% observed and 25% drained (p = 0.14; Power = 0.38), with no mortality differences. One-quarter of observed patients failed, reaching 40% when ventilated >5 days. Twenty-three percent randomized to drainage had complications or ineffectual drains. Conclusion RD was not significantly different with observation. Thus, OPTXs may be cautiously observed in stable patients undergoing short-term PPV when prompt “rescue drainage” is immediately available. As 40% of patients undergoing prolonged (≥5 days) ventilation (PPPV) require drainage, we suggest consideration of chest drainage performed with expert guidance to reduce risk of chest tube complications. Level of evidence Therapeutic study, level II. |
| Databáze: | OpenAIRE |
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