OPTICC: A multicentre trial of Occult Pneumothoraces subjected to mechanical ventilation: The final report - 20/05/21
, Marco Sirois b , Neil Parry c , Derek J. Roberts d , Vincent Trottier e , Sandro Rizoli f , Chad G. Ball a, g , Zhengwen Jimmy Xiao g , Andrew W. Kirkpatrick a, g, h, i, ⁎ Abstract |
Introduction |
Patients with occult pneumothorax (OPTX) requiring positive-pressure ventilation (PPV) face uncertain risks of tension pneumothorax or chest drainage complications.
Methods |
Adults with traumatic OPTXs requiring PPV were randomized to drainage/observation, with the primary outcome of composite “respiratory distress” (RD)).
Results |
Seventy-five (75) patients were randomized to observation, 67 to drainage. RD occurred in 38% observed and 25% drained (p = 0.14; Power = 0.38), with no mortality differences. One-quarter of observed patients failed, reaching 40% when ventilated >5 days. Twenty-three percent randomized to drainage had complications or ineffectual drains.
Conclusion |
RD was not significantly different with observation. Thus, OPTXs may be cautiously observed in stable patients undergoing short-term PPV when prompt “rescue drainage” is immediately available. As 40% of patients undergoing prolonged (≥5 days) ventilation (PPPV) require drainage, we suggest consideration of chest drainage performed with expert guidance to reduce risk of chest tube complications.
Level of evidence |
Therapeutic study, level II.
Le texte complet de cet article est disponible en PDF.Highlights |
• | The composite primary endpoint of Respiratory Distress was not significantly different in either treatment group. |
• | One-quarter of those allocated to observation failed and required drainage. |
• | Nearly 40% of those ventilated for more than 5 days required pleural drainage. |
• | Six percent of those being observed underwent an urgent pleural drainage. |
Keywords : Pneumothorax, Occult pneumothorax, Tube thoracostomy, Critical care, Positive-pressure ventilation
Plan
| ☆ | The OPTICC Trial was partially supported by the Research Committee of the Trauma Trials Collaborative of the Trauma Association of Canada and the Derrick Thompson Award of the Canadian Intensive Care Foundation. |
Vol 221 - N° 6
P. 1252-1258 - juin 2021 Retour au numéro
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