goncal

1. Institute of Medical Microbiology (Drs Wagner and Keller),
University of Zurich; and the Division of Clinical Microbiology
(Dr Frei), University Hospital of Basel.
FINANCIAL/NONFINANCIAL DISCLOSURES: The authors have
reported to CHEST the following: D. S. was supported by grants from
the Swiss National Foundation [Grant PP00P3_128412/1]. None
declared (K. A., D. M. S., M. T., K. J., A. S., L. J., K. W., P. M. K., R. F.).
Drs Affolter and Schumann contributed equally to this article.
CORRESPONDENCE TO: Daiana Stolz, MD, MPH, FCCP, University
Hospital, Petersgraben 4, CH-4031 Basel, Switzerland; e-mail: daiana.
stolz@usb.ch
Copyright Ó 2018 American College of Chest Physicians. Published
by Elsevier Inc. All rights reserved.
DOI: https://doi.org/10.1016/j.chest.2018.06.018
Acknowledgments
Other contributions: The Unyvero P55 Assay cartridges were donated
by Curetis AG. The sponsors of this investigator-initiated project had
no involvement in the design and conduct of the study; the collection,
management, analysis, and interpretation of the data; or the
preparation, review, and approval of the manuscript or decision to
submit the manuscript.
References
1. Waite S, Jeudy J, White CS. Acute lung infections in normal and
immunocompromised hosts. Radiol Clin North Am. 2006;44(2):295-
315, ix.
2. Hiorns MP, Screaton NJ, Muller NL. Acute lung disease in the
immunocompromised host. Radiol Clin North Am. 2001;39(6):1137-
1151, vi.
3. Rano A, Agusti C, Sibila O, Torres A. Pulmonary infections in non-
HIV-immunocompromised patients. Curr Opin Pulm Med.
2005;11(3):213-217.
4. Dunagan DP, Baker AM, Hurd DD, Haponik EF. Bronchoscopic
evaluation of pulmonary infiltrates following bone marrow
transplantation. Chest. 1997;111(1):135-141.
5. White P, Bonacum JT, Miller CB. Utility of fiberoptic bronchoscopy
in bone marrow transplant patients. Bone Marrow Transplant.
1997;20(8):681-687.
Pigtail Catheter vs Chest
Tube as the Initial Treatment
for Pneumothorax
To the Editor:
As bedside ultrasound becomes synonymous with
modern care of patients who are critically ill, pigtail
catheters (PCs) have become increasingly common.
However, head-to-head comparisons with a large-bore
chest tube (LBCT) are lacking. We appreciate the work
of Chang et al1
in the recent systematic review and
meta-analysis in CHEST (May 2018) comparing PCs
and LBCTs as the initial treatment for pneumothorax
drainage and its relevance to current hospital
practices.
In the article, success and recurrence rates were similar
in both groups, but drainage duration was longer with
LBCTs. Considering the position of the LBCT has no
influence on drainage duration for primary spontaneous
pneumothorax,2
we wonder whether the difference truly
reflects longer time needed to close a bronchopleural
fistula rather than hospital practices in removing the
tubes.
The decision to remove a LBCT is at least in part
subjective and impacted by factors external to the
device itself. For example, there is often variability
among unit practices. A LBCT that is managed by the
primary team may be pulled sooner than one managed
by a consulting service that rounds once in the
morning. Additionally, it is reasonable to assume
that the subspecialty of the physician removing the
tube could affect the decision to remove it. It would
be insightful and helpful if the authors could share
their thoughts or have some data on these external
factors.
In any case, the article adds to the relevant body of
literature showing PCs are not inferior and may be
superior to LBCTs. PCs typically result in less pain at
the site of insertion for a simple, uncomplicated
traumatic pneumothorax.3
Additionally, PCs are more
malleable, allowing for alternative placement (anterior
or posterior) when circumstances do not allow for
traditional chest tube placement along the midaxillary
line.
Alvaro Goncalves Mendes Neto, MD
Sao Paulo, SP, Brazil
Thiago A. Jabuonski, MD
New Haven, CT
AFFILIATIONS: From the Hospital Nipo-Brasileiro (Dr Goncalves
Mendes Neto); and the Yale-New Haven Hospital (Dr Jabuonski).
FINANCIAL/NONFINANCIAL DISCLOSURES: None declared.
CORRESPONDENCE TO: Alvaro Goncalves Mendes Neto, MD,
Hospital Nipo-Brasileiro, Rua Pistoia 100, Sao Paulo, SP, 02189-000,
Brazil; e-mail: alvarogmn@usp.br
Copyright Ó 2018 American College of Chest Physicians. Published
by Elsevier Inc. All rights reserved.
DOI: https://doi.org/10.1016/j.chest.2018.05.040
References
1. Chang SH, Kang YN, Chiu HY, Chiu YH. A systematic review
and meta-analysis comparing pigtail catheter and chest tube as
the initial treatment for pneumothorax. Chest. 2018;153(5):
1201-1212.
2. Riber SS, Riber LP, Olesen WH, Licht PB. The influence of chest tube
size and position in primary spontaneous pneumothorax. J Thorac
Dis. 2017;9(2):327-332.
3. Kulvatunyou N, Erickson L, Vijayasekaran A, et al. Randomized
clinical trial of pigtail catheter versus chest tube in injured patients
with uncomplicated traumatic pneumothorax. Br J Surg. 2014;101(2):
17-22.
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