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Can my patient dive after a first episode of primary spontaneous pneumothorax? A systematic review of the literature.

Publication ,  Journal Article
Villela, MA; Dunworth, S; Harlan, NP; Moon, RE
Published in: Undersea Hyperb Med
2018

INTRODUCTION: Patients with prior primary spontaneous pneumothorax (PSP) frequently seek clearance to dive. Despite wide consensus in precluding compressed-air diving in this population, there is a paucity of data to support this decision. We reviewed the literature reporting the risk of PSP recurrence. METHODS: A literature search was performed in PubMed and Web of Science using predefined terms. Studies published in English reporting the recurrence rate after a first PSP were included. RESULTS: Forty studies (n=3,904) were included. Risk of PSP recurrence ranged 0-67% (22 ± 15.5%; mean ± SD). Mean follow-up was 36 months, and 63 ± 39% of recurrences occurred during the first year of follow-up. Elevated height/weight ratio and emphysema-like changes (ELCs) are associated with PSP recurrence. ELCs are present in 59%-89% (vs. 0-15%) of patients with recurrence and can be detected effectively with high-resolution CT scan (sensitivity of 84-88%). Surgical pleurodesis reduces the risk of recurrence substantially (4.0 ± 4% vs. 22 ± 15.5%). CONCLUSION2: Risk of PSP recurrence seems to decline over time and is associated to certain radiological and clinical risk factors. This could be incremented by the stresses of compressed-air diving. A basis for informed patient-physician discussions regarding future diving is provided in this review.

Duke Scholars

Published In

Undersea Hyperb Med

ISSN

1066-2936

Publication Date

2018

Volume

45

Issue

2

Start / End Page

199 / 208

Location

United States

Related Subject Headings

  • Tomography, X-Ray Computed
  • Sensitivity and Specificity
  • Secondary Prevention
  • Risk Factors
  • Recurrence
  • Pulmonary Emphysema
  • Pneumothorax
  • Pleurodesis
  • Physiology
  • Humans
 

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Villela, M. A., Dunworth, S., Harlan, N. P., & Moon, R. E. (2018). Can my patient dive after a first episode of primary spontaneous pneumothorax? A systematic review of the literature. Undersea Hyperb Med, 45(2), 199–208.
Villela, M Alvarez, S. Dunworth, N. P. Harlan, and R. E. Moon. “Can my patient dive after a first episode of primary spontaneous pneumothorax? A systematic review of the literature.Undersea Hyperb Med 45, no. 2 (2018): 199–208.
Villela MA, Dunworth S, Harlan NP, Moon RE. Can my patient dive after a first episode of primary spontaneous pneumothorax? A systematic review of the literature. Undersea Hyperb Med. 2018;45(2):199–208.
Villela, M. Alvarez, et al. “Can my patient dive after a first episode of primary spontaneous pneumothorax? A systematic review of the literature.Undersea Hyperb Med, vol. 45, no. 2, 2018, pp. 199–208.
Villela MA, Dunworth S, Harlan NP, Moon RE. Can my patient dive after a first episode of primary spontaneous pneumothorax? A systematic review of the literature. Undersea Hyperb Med. 2018;45(2):199–208.

Published In

Undersea Hyperb Med

ISSN

1066-2936

Publication Date

2018

Volume

45

Issue

2

Start / End Page

199 / 208

Location

United States

Related Subject Headings

  • Tomography, X-Ray Computed
  • Sensitivity and Specificity
  • Secondary Prevention
  • Risk Factors
  • Recurrence
  • Pulmonary Emphysema
  • Pneumothorax
  • Pleurodesis
  • Physiology
  • Humans