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goncalvesmendesneto2018.pdf

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goncalvesmendesneto2018.pdf

  1. 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. chestjournal.org 725

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