To compare the effectiveness and safety between needle aspiration (NA) and closed thoracostomy (CT) method in adult spontaneous pneumothorax (SP) patients and to explore the most effective and safe protocol by using meta-analysis method.
Materials and Methods
This study was based on Cochrane methodology for conducting meta-analysis. Only randomized controlled trials were eligible for this study. The participants were adults who had SP. The Review Manager Database was used to analyze selected studies.
Nine RCTs involving 665 patients were included. Although the initial success rate of CT was higher, the two groups were not statistically significant (RR 0.87 [95% CI 0.76–1.00]; p = 0.05). Compared the NA group, the use of CT method to treat SP significantly increased complications (RR 0.17 [95% CI 0.06–0.45]; p = 0.0003) and operation rate (RR 0.57 [95% CI 0.35–0.95]; p = 0.03). There was no significant difference in the 1-week success rate, admitted rate, 3-month recurrence rate, 1-year recurrence rate, and recurrence time between the two groups. Subgroup analysis of primary spontaneous pneumothorax (PSP) and secondary spontaneous pneumothorax (SSP) patients showed that the initial success rate of the CT method was higher than NA group (RR 0.74 [95% CI 0.60–0.92]; p = 0.007).
For the treatment of SP, NA method could significantly decrease complication rate, operation rate, as well as hospital stay length, compared with the CT method. Subgroup analysis indicated that the use of CT method in SSP and PSP patients might increase the initial success rate.
This is a preview of subscription content, log in to check access.
Buy single article
Instant unlimited access to the full article PDF.
Price includes VAT for USA
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
This is the net price. Taxes to be calculated in checkout.
Millard FJC, Pepper JR (1995) Pneumothorax. Respiratory medicine. 2nd edn. Saunders, Philadelphia. pp 1569–1579
Melton LJ, Hepper NCG, Offord KP (1987) Incidence of spontaneous pneumothorax in Olmsted County, Minnesota: 1950–1974. Am Rev Respir Dis 29:1379–1382
Kaneda H, Nakano T, Taniguchi Y et al (2013) Three-step management of pneumothorax: time for a re-think on initial management. Interact Cardiovasc Thorac Surg 16(2):186–192
Harvey J, Prescott RJ (1994) Simple aspiration versus intercostal tube drainage for spontaneous pneumothorax in patients with normal lungs. BMJ 309(6965):1338–1339
Baumann MH, Strange C, Heffner JE et al (2001) Management of spontaneous pneumothorax: an American College of Chest Physicians Delphi consensus statement. Chest 119:590–602
MacDuff A, Arnold A, Harvey J (2010) Management of spontaneous pneumothorax: British Thoracic Society pleural disease guideline 2010. Thorax 65(Suppl 2):ii18–ii31.
Tschopp JM, Bintcliffe O, Astoul P et al (2015) ERS task force statement: diagnosis and treatment of primary spontaneous pneumothorax. Eur Respir J 46:321–335
Zhu P, Xia H, Sun Z et al (2019) Manual aspiration versus chest tube drainage in primary spontaneous pneumothorax without underlying lung diseases: a meta-analysis of randomized controlled trials. Interact Cardiovasc Thorac Surg 28(6):936–944
Carson-Chahhoud KV, Wakai A, van Agteren JE, et al (2017) Simple aspiration versus intercostal tube drainage for primary spontaneous pneumothorax in adults. Cochrane Database Syst Rev 9:CD004479
Wang C, Lyu M, Zhou J et al (2017) Chest tube drainage versus needle aspiration for primary spontaneous pneumothorax: which is better? J Thorac Dis 9(10):4027–4038
Aguinagalde B, Zabaleta J, Fuentes M et al (2010) Percutaneous aspiration versus tube drainage for spontaneous pneumothorax: systematic review and meta-analysis. Eur J Cardiothorac Surg 37(5):1129–1135
Kim IH, Kang DK, Min HK et al (2019) A prospective randomized trial comparing manual needle aspiration to closed thoracostomy as an initial treatment for the first episode of primary spontaneous pneumothorax. Korean J Thorac Cardiovasc Surg 52(2):85–90
Ramouz A, Lashkari MH, Fakour S et al (2018) Randomized controlled trial on the comparison of chest tube drainage and needle aspiration in the treatment of primary spontaneous pneumothorax. Pak J Med Sci 34(6):1369–1374
Thelle A, Gjerdevik M, SueChu M, et al (2017) Randomised comparison of needle aspiration and chest tube drainage in spontaneous pneumothorax. Eur Respir J. https://doi.org/10.1183/13993003.01296-2016
Korczyński P, Górska K, Nasiłowski J et al (2015) Comparison of small bore catheter aspiration and chest tube drainage in the management of spontaneous pneumothorax. Adv Exp Med Biol 866:15–23
Higgins JPT, Green S (2005) Cochrane handbook for systematic reviews of interventions. Version 4.2.5
Jadad AR, Moore RA, Carroll D et al (1996) Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials 17(1):1–12
Ho KK, Ong ME, Koh MS et al (2011) A randomized controlled trial comparing minichest tube and needle aspiration in outpatient management of primary spontaneous pneumothorax. Am J Emerg Med 29(9):1152–1157
Ayed AK, Chandrasekaran C, Sukumar M (2006) Aspiration versus tube drainage in primary spontaneous pneumothorax: a randomised study. Eur Respir J 27(3):477–482
Noppen M, Alexander P, Driesen P et al (2002) Manual aspiration versus chest tube drainage in first episodes of primary spontaneous pneumothorax: a multicenter, prospective, randomized pilot study. Am J Respir Crit Care Med 165:1240–1244
Andrivet P, Djedaini K, Teboul JL et al (1995) Spontaneous pneumothorax. Comparison of thoracic drainage vs immediate or delayed needle aspiration. Chest 108(2):335–339
Harvey J, Prescott RJ (1994) Simple aspiration versus intercostal tube drainage for spontaneous pneumothorax in patients with normal lungs. Br Thorac Soc Res Comm BMJ 309(6965):1338–1339
Tupchong K, Foran M, Koyfman A (2014) Can Heimlich valves along with intercostal catheters be used to safely manage pneumothoraces for outpatients? Ann Emerg Med 64:660–661
Light RW (1995) Pneumothorax. In: Light RW (ed) Pleural diseases, 3rd edn. Williams and Wilkins, Baltimore (MD), pp 242–277
Ohata M, Suzuki H (1980) Pathogenesis of spontaneous pneumothorax: with special reference to the ultrastructure of emphysematous bullae. Chest 77:771–776
Bense L, Eklund G, Wiman LG (1987) Smoking and the increased risk of contracting spontaneous pneumothorax. Chest 92:1009–1012
Bense L, Eklund G, Wiman LG (1992) Bilateral bronchial anomaly: a pathogenetic factor in spontaneous pneumothorax. Am Rev Respir Dis 146:513–516
Gupta D, Hansell A, Nichols T et al (2000) Epidemiology of pneumothorax in England. Thorax 55(8):666–671
Sahn SA, Heffner JE (2000) Spontaneous pneumothorax. N Engl J Med 342(12):868–874
Hallgrímsson JG (1978) Spontaneous pneumothorax in Iceland with special reference to the idiopathic type. A clinical and epidemiological investigation. Scand J Thorac Cardiovasc Surg Suppl 21:1–85
Sassoon CS (1995) The etiology and treatment of spontaneous pneumothorax. Curr Opin Pulm Med 1(4):331–338
Huang Y, Huang H, Li Q et al (2014) Approach of the treatment for pneumothorax. J Thorac Dis 6(Suppl 4):S416–S420
Conflict of interest
The authors declare that they have no competing interests.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
Cite this article
Tan, J., Chen, H., He, J. et al. Needle Aspiration Versus Closed Thoracostomy in the Treatment of Spontaneous Pneumothorax: A Meta-analysis. Lung (2020). https://doi.org/10.1007/s00408-020-00322-9
- Needle aspiration
- Closed thoracostomy
- Tube drainage
- Spontaneous pneumothorax