EC Pulmonology and Respiratory Medicine

Background: Spontaneous pneumothorax is a common condition. Although benign, it can be life-threatening. The main complication is recurrence noted in 20 - 60% of cases. The management of primary and secondary spontaneous pneumothorax remains controversial and many treatment options are available to the clinician, with thoracic drainage remaining the most common therapeutic modality.

Objective of the Study: To study the indication and the interest of the chest tube clamp test in the management of pneumothorax.

Methods: A survey of the practices allowed to carry out a mapping of the management of the drained patient with the concerned services reinforced and followed by a comparative prospective study on the spontaneous pneumothorax admitted to the pneumology service of Marrakech. Variables analyzed included; demographics, duration of chest tube drainage, number and size of pneumothorax recurrences, required interventions, hospital stay, morbidity and mortality.

Results: A total of 44 patients (90% male, mean age 45 years) was included in the study. In the PS group without clamping, there were fewer relapses, with a smaller mean pneumothorax size (p = 0.01) and fewer interventions were required (p = 0.042) with a shorter hospital stay (p = 0.04) compared with the clamp group. In the clamp group, pneumothorax recurrences tended to be greater (p = 0.04), a larger mean pneumothorax size and ultimately more interventions eventually required. Three cases involved patients with idiopathic spontaneous pneumothorax, while thirteen cases were secondary: emphysema bulla (6 cases), tubercular cavern (3 cases), neoplastic (2 cases) and one case each of PID and Histiocytosis X. No deaths were reported.

Conclusion: The clamp test is useless before the removal of the chest tube in the management of spontaneous pneumothorax in terms of recurrent pneumothorax.

Keywords: Clamping; Chest Tubes; Spontaneous Pneumothorax

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