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Respir Med. 2018 Apr;137:152-166. doi: 10.1016/j.rmed.2018.03.009. Epub 2018 Mar 6.

Efficacy of treatments in primary spontaneous pneumothorax: A systematic review and network meta-analysis of randomized clinical trials.

Author information

1
Department of Cardiovascular and Thoracic Surgery, Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, 70000, Viet Nam; Department of Medical Statistic and Informatics, Faculty of Public Health, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, 70000, Viet Nam. Electronic address: nguyenlamvuong@ump.edu.vn.
2
Faculty of Medicine, Al-Azhar University, Cairo, 11884, Egypt. Electronic address: Abdelrahman.elshafay@azhar.edu.eg.
3
Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, 70000, Viet Nam. Electronic address: lephuongthao294@gmail.com.
4
Faculty of Medicine, Mansoura University, Mansoura, 35653, Egypt. Electronic address: ahmed51@students.mans.edu.eg.
5
Kasr Al-Aini School of Medicine, Cairo University, Cairo, 44523, Egypt. Electronic address: drislamashraf91@gmail.com.
6
Faculty of Medicine, Al-Azhar University, Cairo, 11884, Egypt. Electronic address: khaledelsabaa4@gmail.com.
7
Kasr Al-Aini School of Medicine, Cairo University, Cairo, 44523, Egypt. Electronic address: dresraaomran@gmail.com.
8
Guizhou Provincial People's Hospital, Guiyang, China. Electronic address: yufuxun@yahoo.com.
9
Department of Immunogenetics, Institute of Tropical Medicine (NEKKEN), Graduate School of Biomedical Sciences, Nagasaki University, 1-12-4 Sakamoto, Nagasaki 852-8523, Japan. Electronic address: hiraken@nagasaki-u.ac.jp.
10
Evidence Based Medicine Research Group & Faculty of Applied Sciences, Ton Duc Thang University, Ho Chi Minh City, Viet Nam; Department of Clinical Product Development, Institute of Tropical Medicine (NEKKEN), Leading Graduate School Program, and Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan. Electronic address: nguyentienhuy@tdt.edu.vn.

Abstract

BACKGROUND:

Primary spontaneous pneumothorax (PSP) remains a significant global health problem. Despite general agreement, an official algorithm for the management of PSP still does not exist.

OBJECTIVES:

Evaluating the efficacy of all available treatments in PSP.

METHODS:

A systematic search of 12 electronic databases was performed to identify all randomized controlled trials (RCTs) of any treatments in PSP. The primary endpoint was recurrence incidence; secondary were an immediate success, complication and hospitalization days. All available outcomes were included in frequentist network meta-analysis.

RESULTS:

4262 patients of 29 RCTs were included. In patients with first episode of PSP, video-assisted thoracoscopic surgery (VATS), tube drainage and aspiration had no significant difference regarding recurrence. Chemical pleurodesis significantly reduced the recurrent incidence of 46% compared with aspiration and 54% compared with tube drainage. VATS and aspiration significantly decreased hospitalization days compared with tube drainage. In patients with recurrent or persistent PSP, thoracotomy with mechanical pleurodesis has a higher rank than VATS with or without pleurodesis in preventing recurrence, with no significant difference. VATS alone significantly reduced complications compared with all others treatments, except thoracotomy with abrasion.

CONCLUSIONS:

Aspiration and tube drainage have no significant difference in treating patients with first episode of PSP regarding recurrence. Aspiration reduced hospitalization days when compared with tube drainage. Thoracotomy with mechanical pleurodesis and VATS with or without pleurodesis are not significantly different in preventing recurrence in patients with recurrent or persistent PSP. VATS alone reduced complications compared with others treatments except for thoracotomy with abrasion.

KEYWORDS:

Network meta-analysis; Primary spontaneous pneumothorax; Systematic review

PMID:
29605200
DOI:
10.1016/j.rmed.2018.03.009
[Indexed for MEDLINE]

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