Pneumothorax, Bullous Disease, and Emphysema

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Abstract

This article addresses several distinct but related pulmonary conditions that are commonly referred to general thoracic surgeons for decision making and management. The management of various types of pneumothorax is reviewed, with particular attention to the selection of the appropriate level of surgical intervention. The related entities of bullous lung disease and diffuse emphysema are discussed, with a focus on the identification of appropriate circumstances for surgical intervention. The summarized work and the treatment recommendations are supported with an extensive bibliography of important work in this area.

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Most cited references 91

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Management of spontaneous pneumothorax: an American College of Chest Physicians Delphi consensus statement.

J Luketich, , David R. Light … (2001)

Provide explicit expert-based consensus recommendations for the management of adults with primary and secondary spontaneous pneumothoraces in an emergency department and inpatient hospital setting. The use of opinion was made explicit by employing a structured questionnaire, appropriateness scores, and consensus scores with a Delphi technique. The guideline was designed to be relevant to physicians who make management decisions for the care of patients with pneumothorax. Decisions for observation, chest tube placement, surgical interventions, and radiographic imaging. Effectiveness of pneumothorax resolution, duration of and patient tolerance of care, and pneumothorax recurrence. Literature review from 1967 to January 1999 and Delphi questionnaire submitted in three iterations to a multidisciplinary physician panel. The guideline development group determined by consensus the relevant outcomes to be considered in developing the Delphi questionnaire. The type and magnitude of benefits, harms, and costs expected for patients from guideline implementation. Management decisions vary between patients with primary or secondary pneumothoraces, with observation of small pneumothoraces being appropriate only for primary pneumothoraces. The level of consensus varies regarding the specific interventions indicated, but agreement exists for the general principles of care. Recommendations were peer reviewed by physician experts and were reviewed by the American College of Chest Physicians (ACCP) Health and Science Policy Committee. The guideline recommendations will be published in printed and electronic form with distribution of synopses for patients and health care providers. Contents of the guideline will be incorporated into continuing medical education programs. The ACCP.

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BTS guidelines for the management of spontaneous pneumothorax.

, Danielle Harvey, David T Arnold … (2003)

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Patients at high risk of death after lung-volume-reduction surgery.

(2001)

Lung-volume-reduction surgery is a proposed treatment for emphysema, but optimal selection criteria have not been defined. The National Emphysema Treatment Trial is a randomized, multicenter clinical trial comparing lung-volume-reduction surgery with medical treatment. After evaluation and pulmonary rehabilitation, we randomly assigned patients to undergo lung-volume-reduction surgery or receive medical treatment. Outcomes were monitored by an independent data and safety monitoring board. A total of 1033 patients had been randomized by June 2001. For 69 patients who had a forced expiratory volume in one second (FEV1) that was no more than 20 percent of their predicted value and either a homogeneous distribution of emphysema on computed tomography or a carbon monoxide diffusing capacity that was no more than 20 percent of their predicted value, the 30-day mortality rate after surgery was 16 percent (95 percent confidence interval, 8.2 to 26.7 percent), as compared with a rate of 0 percent among 70 medically treated patients (P<0.001). Among these high-risk patients, the overall mortality rate was higher in surgical patients than medical patients (0.43 deaths per person-year vs. 0.11 deaths per person-year; relative risk, 3.9; 95 percent confidence interval, 1.9 to 9.0). As compared with medically treated patients, survivors of surgery had small improvements at six months in the maximal workload (P= 0.06), the distance walked in six minutes (P=0.03), and FEV1 (P<0.001), but a similar health-related quality of life. The results of the analysis of functional outcomes for all patients, which accounted for deaths and missing data, did not favor either treatment. Caution is warranted in the use of lung-volume-reduction surgery in patients with emphysema who have a low FEV1 and either homogeneous emphysema or a very low carbon monoxide diffusing capacity. These patients are at high risk for death after surgery and also are unlikely to benefit from the surgery.

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Author and article information

Contributors

Bryan F. Meyers

Journal

Journal ID (nlm-ta): Surg Clin North Am

Journal ID (iso-abbrev): Surg. Clin. North Am

Title: The Surgical Clinics of North America

Publisher: Published by Elsevier Inc.

ISSN (Print): 0039-6109

ISSN (Electronic): 1558-3171

Publication date PMC-release: 16 October 2010

Publication date (Print): October 2010

Publication date (Electronic): 16 October 2010

Volume: 90

Issue: 5

Pages: 935-953

Affiliations

[a ]Division of Cardiothoracic Surgery, Department of Surgery, University of Louisville School of Medicine, Louisville, KY, USA

[b ]Heart and Lung Institute, St Joseph's Hospital and Medical Center, Phoenix, AZ, USA

[c ]Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, Barnes-Jewish Hospital Plaza Street, Saint Louis, MO 63110-1013, USA

Author notes

[∗ ]Corresponding author. One Barnes-Jewish Hospital Plaza Street, 3108 Queeny Tower, Saint Louis, MO 63119-2408. meyersb@ 123456wustl.edu

Article

Publisher ID: S0039-6109(10)00076-9

DOI: 10.1016/j.suc.2010.06.008

PMC ID: 7125821

PubMed ID: 20955876

SO-VID: 714ea6fa-4845-49c6-b918-bfb7bb247a59

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Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

Pneumothorax, Bullous Disease, and Emphysema

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Abstract

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Most cited references 91

Management of spontaneous pneumothorax: an American College of Chest Physicians Delphi consensus statement.

BTS guidelines for the management of spontaneous pneumothorax.

Patients at high risk of death after lung-volume-reduction surgery.

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