Pigtail Tube Drainage as a Safe and Effective Alternative to Traditional Chest Tube Thoracostomy in Adults with Spontaneous Pneumothoraces: A Systematic Review

Background: Primary spontaneous pneumothorax occurs in young, healthy populations, usually males, in the absence of lung disease. Secondary spontaneous pneumothorax occurs in older adults who have underlying lung disease such as COPD, emphysema, or a malignant growth. The estimated incidence of spontaneous pneumothorax is 7.4 to 18 per 100,000 for males and 1.2 to 6 per 100,000 in females. Traditionally pneumothoraces have been treated with chest tube(s) but some have shown clinical success with small pigtail tube drainage. Relevant evidence was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) tool developed by the GRADE Working Group. Method: An exhaustive search of available medical literature was performed using MEDLINE, Google Scholar, EBM multifile, and CINAHL using “pigtail” “adult” and “pneumothorax” individually and in combination. This search focused on articles published since 1999 pertaining to chest tube thoracostomy versus pigtail tube drainage. Results: Four articles meeting the search criteria were included in the review. These studies evaluated length of hospital stay, time to extubation, total cost, and success rates. Two studies showed a decrease in length of hospital stay as well as decreased time to extubation. One study demonstrated a decrease in total cost and 3 studies reported success rates as acceptable for pigtail tube drainage prior to chest tube thoracostomy. Conclusion: Pigtail tube drainage is a safe and effective alternative to chest tube thoracostomy in adults with spontaneous pneumothoraces. More studies are required as these articles were given a GRADE of low.