January 30, 2020
A novel New Zealand and Australian research collaboration has shown that a fresh ‘hands-off’ approach to treating a common lung condition not only lessens pain, but significantly reduces injury, infection and time spent in hospital.
“This definitive study shows that sometimes, medical intervention is not always in a patient’s best interest and that by stepping back and doing less, doctors can actually improve patient recovery” says study co-author and respiratory physician Dr Kyle Perrin from the Medical Research Institute of New Zealand (MRINZ).
Every year an estimated 500-600 New Zealanders turn up at hospital emergency departments suffering from a collapsed lung (pneumothorax). The condition can be caused by an underlying lung disease or, most commonly, for no obvious reason at all. It occurs when a spontaneous leak from the surface of the lung causes air to collect inside the chest, which in turn causes pain and breathing difficulties.
For decades now, standard hospital treatment for a pneumothorax has been ‘interventional’, with doctors inserting a plastic tube into the patient’s chest to drain the collected air to help the lung reinflate. Not only is this treatment often painful, but it can lead to organ injury, bleeding, infection and sometimes additional surgery if the air leak continues.
A six-year study involving more than 300 New Zealand and Australian patients, published today in the New England Journal of Medicine (NEJM), shows that this traditional ‘interventional’ approach to treating a collapsed lung results in significantly longer hospital stays and greater complications compared to a more hands-off ‘conservative’ approach – treating patients with simple pain relief, observing them, and then sending them home to await the lung’s natural re-expansion and recovery.
“These findings are a game-changer in terms of how this common lung problem lung should now be treated” says Dr Perrin.” We’ve been putting tubes into people with collapsed lungs since the beginning of the 20th century thinking we were doing our best to treat the condition. Now, this study, the largest ever undertaken on patients with pneumothorax worldwide, makes it clear that conservative treatment is the best approach, even when the lung collapse is quite large. Our study found that 80% of patients required no intervention at all”.
A total of 316 patients took part in the trial, conducted by more than 100 clinical researchers in 39 New Zealand and Australian hospitals. Of those 316 patients, 154 received the standard interventional lung drainage management, while the remaining 162 were managed conservatively with just pain killers and observation alone. The results showed that the latter conservative group’s outcome was ‘non-inferior’ to the interventional group in terms of the pneumothorax resolving within an eight-week timeframe. What’s more, the conservative approach resulted in a significantly lower risk of complications, quartered the length of patients’ hospital stay, and halved the risk of recurrance.
“We’ve demonstrated that this conservative, non-interventional approach is safe” says Dr Perrin. “Patients can be sent home to recover, get back to work and get on with their normal lives more efficiently and effectively, avoiding all the complications that go along with sticking a tube into the chest.”.
Study co-author and lead investigator for Auckland hospital in the trial, Associate Professor Peter Jones from the University of Auckland, says this research will change medical practice for the treatment of a collapsed lung and have worldwide impact. It’s a great example of the need for research in emergency situations where many of the treatments used ‘routinely’ do not have strong evidence to support them” says Associate Professor Jones. “Studies like this are the only way to truly find whats best and safest for patients”.
The study was coordinated in New Zealand by the MRINZ and in Australia by the Centre for Clinical Research in Emergency Medicine at Royal Perth Hospital. Funding for the New Zealand arm of the study was provided by the Health Research Council of New Zealand (HRC) and the Greenlane Research and Education Fund.
If you have Institutional Access, you can read the full article published in the New England Journal of Medicine (NEJM) at: http://bit.ly/PSP-NEJM