PP1 THE RISING OF SELDINGER: AN EVOLUTION OF CHEST DRAINAGE IN PNEUMOTHORAX

Shan Kai Ing, Yih Hoong Lee, Shu Feng Tan, Nga Hung Ngu
1 Division of Respiratory Medicine, Sibu Hospital, Ministry of Health Malaysia, Sibu, Sarawak, Malaysia

Introduction:

In recent years, the Seldinger technique for chest drainage in pneumothorax has gained global preference over the conventional method, given its less invasive nature.

Objectives: 

To compare patient outcomes with pneumothorax managed by conventional chest drainage versus Seldinger technique chest drainage.

Methodology: 

This was a retrospective, observational cohort study conducted at Sibu Hospital from January 2021 to February 2024. Pneumothorax patients who underwent chest drainage were divided into two groups: conventional and Seldinger technique. The primary outcome was complications related to chest drainage. Secondary outcomes included length of stay (LOS), duration of chest drainage, and mortality. Data analysis was done using SPSS version 22.0.

Results: 

Of 123 patients (65.9% male), 86 (69.9%) underwent conventional chest drainage for pneumothorax. In this study, subcutaneous emphysema (63.2%) and tube dislodgement (13.9%) were the commonest chest drain-related complications. Compared to the Seldinger group, the conventional group was significantly associated with the development of subcutaneous emphysema (OR 27.6, 95%CI:5.24-145.94, p<0.001), along with the higher insertion failure (8.1% vs. 0%) and tube dislodgement (11.6% vs. 2.7%). Besides, three patients with insertion failure in the conventional group were subsequently salvaged by the Seldinger technique. Unfortunately, 1 case of complication-related death was reported in the conventional group. Albeit no significant difference was found in the LOS and mortality, the conventional group recorded a longer duration of chest drainage than the Seldinger group (OR 1.68, 95%CI:1.45-1.94, p<0.001). Focusing on tension pneumothorax, the secondary outcomes of the two groups did not differ significantly. Furthermore, no significant association was found between the size of the chest drain and the outcomes.

Conclusions: 

Compared to conventional chest drainage in pneumothorax, the Seldinger technique is associated with better outcomes, particularly with a lower risk of complications and a shorter duration of chest drainage.