Thanks, Francis.
I also came across quite a number of failure cases that the pneumothorax
recurred in different extent. I am a bit doubtful how effective aspiration
works. I am now collecting the data in my department to see the margin of
benefit of aspiration.
Perhaps the new guidelines from BTS can give us more inspiration.
Regards,
Dr. Axel SIU
Senior Medical Officer
A&E Department
North District Hospital
Hong Kong
----- Original Message -----
From: Dr Francis Andrews <[log in to unmask]>
To: <[log in to unmask]>
Sent: Thursday, November 25, 1999 12:29 AM
Subject: aspiration of spontaneous pneumothorax
> in reply to Axel SIU, HKNET
>
> sorry about the delay in replying but I've only just joined this mail
> thing. I too am interested in the management of spontaneous
> pneumothorax. Myself and Tom Carrigan (A&E spr's) did an audit on
> spontaneous pneumothorax in the A&E departments at York and Leeds
> General infirmary (not published yet). We found that adherance to the
> guidelines reached abuout 50% of cases, with over- and under-treatment
> being problems. What was interesting was the high number of technical
> failures of (correctly indicated) aspiration-more so than previously
> published figures in the BMJ (1993). We suspect that the original data
> claiming high success with aspiration included patients with repeated
> attempts at aspiration. We suspect that using larger and stiffer
> canulae may overcome some of the problems.
>
> As for my experiences-I aspirated a complete spontaneous pneumothorax in
> Preston A&E using a needle (BTS guidelines), with virtually complete
> resolution. The patient was kept overnight and wandered off to the
> canteen the next morning. He returned complaing of new brethlessness
> and radiologically had a tension pneumothorax. I've known about two
> similar cases-hence I'm not happy about any of these patients being sent
> home after initial apparent successful treatment. I've often found the
> procedure of needle aspiration easier with miazolam sedation iv and I've
> successfully treated a 13 and 15 year old using this. There is nothing
> that I could find in the literature about when to re-Xray etc and my
> impresssion is that the BTS guidelines have not been validated
> properly. Apparently they are being revised for next year.
>
> hope this is of some use
>
> Francis Andrews FFAEM
> lecturer in intensive care, Liverpool
>
>
>
>
%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%
|