71312 - Ambulatory True-Close Thoracic Vent, an outpatient management of Pneumothorax – results of 24 years' experience

Introduction Traditional guidelines for the primary treatment of pneumothorax differ and include simple aspiration, small-bore catheter or chest tube drainage. Treatment via conventional chest tube drainage connected to a suction system is usually associated with hospitalization for approximately 6 days, immobilization, and discomfort. However, reliable patients who do not want to be hospitalized can safely be treated as outpatients with a small-bore catheter attached to a Heimlich valve, True-Close Thoracic Vent (TV). We started using TV at Capio S:t Görans hospital (CStG) in 1999 in cooperation with dr Leif Dernevik, Department of Thoracic Surgery, Sahlgrenska University Hospital. Method TV is a minimally invasive, immediate salvage device for the treatment of pneumothorax. Indications are primary & secondary spontaneous and iatrogenic pneumothorax. The exclusion criteria: hydro/hemopneumothorax, patient refusal, dementia or psychologically unstable, and underlying pulmonary disease requiring supplemental oxygen. Patients are identified and operated on in the ward or postop area. Operation technique: 2nd intercostal-space (IC2) in the midclavicular line (MCL), local anesthetics together with light iv sedation, mini thoracotomy (no-bore safe ATLS-technique), aspiration of air and fixation of TV. Post drain x-ray is conducted and most of the patients are sent home the next day with a 5+2-day ambulatory treatment plan. Result 2016-2023: Cases n 445 Male/female 75/25% Success rate 93% AVLOS 2,3 days Mortality 0% Morbidity grade 3b, one patient (erroneous placement in IC1 MCL). Discussion TV is a safe, cost-effective ambulatory method for treatment of pneumothorax. By using this technique, CStG has saved approximately 2800 beds since 1999 compared to non-ambulatory pneumothorax care.