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▶Ep 7 · 26:30
So CAT scans may be overcalling. Findings that may be more common than we've that we've historically have expected and then is that driving us to make a decision based upon a finding that may not be clinically relevant. So I don't do CAT scans on anybody anymore.
I think the evidence beyond, now, this is just pleurodesis, OK? Pleurodesis for an initial operations for spontaneous pneumothorax, I'm, I'm sure that there's any evidence that supports that that's gonna decrease your, your recurrence rates.
epidemiologicalPrimary spontaneous pneumothorax is more common in males by approximately 3 to 1 ratio↗
▶Ep 7 · 3:05
clinicalCT scan data fairly convincingly shows that it is probably not beneficial with regard to changing treatment parameters or outcomes for spontaneous pneumothorax↗
▶Ep 7 · 3:32
clinicalIn multi-institutional retrospective trial, chest tubes worked about 50% of the time for spontaneous pneumothorax↗
▶Ep 7 · 5:00
clinicalThe failure rate for patients who get a chest tube and resolve is about 50% - they will be back and have to have another operation↗
▶Ep 7 · 5:24
clinicalPatients who get a chest tube and fail in the hospital and subsequently go on to VATS still have a failure rate of around 25 to 30%↗
▶Ep 7 · 8:02
clinicalPatients who get immediate VATS have about a 10 to 15% failure rate↗
▶Ep 7 · 8:23
clinicalPatients who get a chest tube and then VATS have higher failure rates (25%) than those who get immediate VATS, possibly because they are predisposed to recurrence↗
▶Ep 7 · 9:49
epidemiologicalIn most large studies for primary spontaneous pneumothorax, the mean age is around 20 to 22 years, making this primarily a young adult disease↗
▶Ep 7 · 9:49
guidelineThe Society of Thoracic Surgery in adult patients recommends primary aspiration for spontaneous pneumothorax↗
▶Ep 7 · 9:49
epidemiologicalThe average age in pediatric spontaneous pneumothorax studies has been between 15.5 and 16 years↗
▶Ep 7 · 11:40
clinicalOf 81 patients in retrospective study across 3 institutions over 13 years, none presented with tension physiology from spontaneous pneumothorax↗
▶Ep 7 · 11:40
quoteI have never, and nor have anyone that I've asked ever seen a patient come in in extremis, uh, with tension pneumothorax from a spontaneous pneumothorax.↗
▶Ep 7 · 14:22
clinicalIn Midwest Consortium prospective study, 50% of patients who got aspiration failed within 6 hours↗
▶Ep 7 · 14:39
epidemiologicalIn the aspiration study, 33 patients presented across 9 institutions over 2 years↗
▶Ep 7 · 15:50
clinicalOf 17 patients who failed aspiration, 12 received chest tubes and 83% of those had persistent air leak requiring VATS or had recurrent pneumothorax↗
▶Ep 7 · 16:38
clinicalOf 5 patients who went directly to VATS after failed aspiration, none recurred↗
▶Ep 7 · 18:27
clinicalOf 16 patients who passed aspiration and went home, 40% came back with recurrent pneumothorax↗
▶Ep 7 · 18:39
clinicalThe positive predictive value of aspiration in treating pneumothorax was 83% with negative predictive value of 56%↗
▶Ep 7 · 22:08
quoteI start everybody out with aspiration at this point, I don't put chest tubes in anybody.↗
▶Ep 7 · 23:27
clinicalThere is good data suggesting that pleurodesis is not beneficial in preventing recurrence of spontaneous pneumothorax↗
▶Ep 7 · 23:27
quoteI do not do pleurodesis. I think that Um, there's good data that suggests that pleurodesis is not beneficial in preventing recurrence.↗
▶Ep 7 · 23:48
clinicalIn three-institution retrospective data, patients who underwent VATS with pleurodesis had the same recurrence rate as those who underwent VATS alone↗
▶Ep 7 · 24:20
clinicalA large Chinese trial of 289 patients over 3 years (average age 22) randomized patients to wedge resection with or without mechanical pleurodesis using standardized sandpaper abrasion and showed identical recurrence rates↗
▶Ep 7 · 24:55
quoteI think the evidence beyond, now, this is just pleurodesis, OK? Pleurodesis for an initial operations for spontaneous pneumothorax, I'm, I'm sure that there's any evidence that supports that that's gonna decrease your, your recurrence rates.↗
▶Ep 7 · 26:05
quoteI think really where the, the, the expansion of CAT scan use or CT scan use was, if there's bilateral bleb, should you do both blebectomies at the same time, right?↗
▶Ep 7 · 26:30
quoteSo CAT scans may be overcalling. Findings that may be more common than we've that we've historically have expected and then is that driving us to make a decision based upon a finding that may not be clinically relevant. So I don't do CAT scans on anybody anymore.↗
▶Ep 7 · 26:30
clinicalCT scans may identify blebs that are incidental findings in patients who never develop pneumothorax, similar to traumatic pneumatoceles that rarely rupture↗
▶Ep 7 · 27:31
clinicalPleurectomy is an arduous, bloody operation that is super painful for children, usually requiring epidurals, with patients hospitalized for a week or 10 days↗
▶Ep 7 · 27:31
clinicalFor patients with multiple recurrences after VATS, thoracoscopic pleurectomy of parietal pleura from apex down to a couple ribs above diaphragm is performed↗
▶Ep 7 · 28:51
opinionFor recurrent recurrent pneumothorax cases, talc pleurodesis would be used if available because it is an appropriate population where preventing reoperation is critical↗
▶Ep 7 · 30:15
clinicalFor small apical pneumothorax after pleurodesis where lung is fixed to chest wall and patient is asymptomatic, observation with repeat chest X-ray in 48 hours is appropriate rather than operation↗
