Ann Thorac Surg 2009;88:979-981. doi:10.1016/j.athoracsur.2009.03.065
© 2009 The Society of Thoracic Surgeons
New Technology
Pocket-Sized Heimlich Valve (Pneumostat) After Bullae Resection: A 5-Year Review
Mohd Ramzisham Abdul Rahman, MSa,*,
Ooi Su Min Joanna, Mmedb,
Abdullah Mohd Fikri, FRCSa,
Syed Mohd Adeeb, MSa,
Dimon Mohd Zamrin, MSa
a Division of Cardiothoracic Surgery, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
b Division of Cardiothoracic Anesthesia, Heart and Lung Centre, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
Accepted for publication March 17, 2009.
* Address correspondence to Dr Abdul Rahman, Division of Cardiothoracic Surgery, Department of Surgery, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob, Latif, Cheras, Kuala Lumpur, 56000, Malaysia (Email: ramzisham{at}hotmail.com).
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Abstract
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Purpose: This study was conducted to evaluate the practicability, effectiveness, and potential complications of a newly improvised pocket-sized Heimlich valve named the Pneumostat (Atrium Medical Corp, Hudson, NH).
Description: This was a retrospective review of 98 patients who underwent bullae resection after recurrent spontaneous pneumothorax at our center from January 2002 until June 2007. Data from the patients' files were collected and analyzed.
Evaluation: The mean age of the patients was 28.5 years (range, 17 to 52). There were 80.6% smokers and 5.1% diabetics. Pneumostat (Atrium Medical Corp) was inserted and the patients started to ambulate on day 1 after surgery. The mean hospital stay was 3.08 days. The mean duration of the affected lung to fully expand and the drain to be removed was 7.5 days. No other complications occurred, apart from drain site wound infection in 4.1% of the patients, which resolved with oral antibiotics and simple wound care.
Conclusions: This review proved that the pocket-sized Pneumostat was safe and practical in this group of patients. It improved the patients' recovery in terms of mobilization and reduced the length of hospital stays with no significant complications.
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Introduction
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Prolonged air leak after bullae resection is a common and increasing problem. This is due to the dead space within the pleura after a part of the lung has been resected, which will take time for the remaining lung to be fully expanded and sealed between the two pleural layers [1]. Excessive and prolonged air leak has been treated with the conventional underwater seal drainage system, and this is technically troublesome to manage restriction of patient ambulation, and will definitely lead to increased length of hospital stay with significant healthcare costs and possible patient dissatisfaction [2–4]. Since the introduction of the new pocket-size Heimlich valve named the Pneumostat (Atrium Medical Corp, Hudson, NH), we conducted this review to assess the practicability, effectiveness, and complications in using the Pneumostat (Atrium Medical Corp) after bullae resection for spontaneous recurrent pneumothorax.
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Technology
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We started using the improved pocket-sized Heimlich valve drainage system (ie, the Pneumostat) in 2002. The device has a closed drainage system with an air leak detector that is cheap, small, and can be safely handled by the patient. It can be attached to any size chest drain and clipped to the patient's garment (Fig 1) while the patient ambulates normally. Hence this device can replace the conventional underwater seal drainage system while waiting for the lung to be fully expanded [5].
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Technique
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This was a retrospective review of all patients underwent bullectomy after recurrent spontaneous pneumothorax either by video-assisted thoracoscopic surgery or a thoracotomy at our center between January 2002 and October 2007. The study was approved by the research and ethical committee of the Universiti Kebangsaan Malaysia (Reference code, FF-005-2007). In view of the retrospective study, the individual patient was not identified; the need for patient consent for the study was waived by the committee. Ninety-eight patients included in this review had single-sided recurrent spontaneous bullae rupture. Intravenous Augmentin (1.2 g) was given to all patients at induction. All patients had isolated lung ventilation during surgery. An abrasion pleurodesis technique of the parietal pleural was routinely used, and a single, apical drain was inserted at the end of the procedure. Patients were routinely managed in the intensive care unit with a morphine infusion on the day of surgery. Eight hourly orally prescribed Tramadal (50 mg) was given for analgesia on the following day. All patients had the Pneumostat fixed to their chest drain on postoperative day 1 before they started ambulating. Patients were discharged home with the Pneumostat in situ with a twice weekly outpatient clinic follow-up with clinical and radiologic examinations.
Data were collected from the hospital files, and statistical analysis was performed using the SPSS version 12.0 (Windows Software Package; SPSS Inc, Chicago, IL). The quantitative and qualitative variables were analyzed using Student's t and 
2 tests, respectively. A p value of < 0.05 was considered significant.
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Clinical Experience
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A total of 98 patients were reviewed. All were male patients (mean age, 28.5 years; range, 17 to 52). Fifty-one patients underwent a thoracotomy performed by using video-assisted thoracic surgery, whereas 47 patients underwent a thoracotomy. Among these patients, 80.6% were smokers and 5.1% suffered from diabetes mellitus. The mean hospital stay was 3.08 days (range, 3 to 5 days). The duration of the affected lung to fully expand for the drain to be removed was 5 to 14 days with a mean of 7.5 days. The decision to remove the chest drain was based on clinical examination and chest roentgenogram of the patients during outpatient review. No other complications occurred, apart from superficial drain site wound infection in 4.1% of the patients, which only required oral antibiotic treatment and simple antiseptic dressing (Table 1). All of the patients expressed the ease of handling the Pneumostat during the recovery period. According to our records, up until the day this article was written, none of the patients had recurrent pneumothoraxes on the previously operated site.
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Comment
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The Heimlich valve, which was first introduced in 1968, gained a worldwide popularity. Since then, many improved versions were published for a wide range of clinical practices. This pocket-sized Pneumostat was very well designed for its safety and practicability as previously described. In addition, this product has a 30 mL chamber to collect fluid. The only access at the bottom of the device acts like a one-way valve, which is conveniently handled by the patient to aspirate any accumulated fluid. The clip that enables the device to be attached to the patient's garment allows freedom of mobility and remains gravity-based, dependent on any position of the patient.
We reviewed this specific group of healthy young patients with no other significant morbidity. Diseases and hospitalization in this group will have significant impact to them, family members, and overall economic contributions. We observed the benefits of early fixation of the device, allowing postoperative patients to gain their self confidence and sense of independence at the earliest possible time. Early mobilization allowed the remaining lungs to be fully expanded to fill the space created by the surgery. Ambulation obviously further reduces the potential postoperative complications, such as atelectasis and thromboembolism. Our patients' satisfaction of early discharge and reduction of the hospital bills were overwhelming. Fortunately, no major complication was noted apart from minor chest drain site wound infections, which were more common in diabetic patients. Only 4 of the patients had infection and 3 of them were diabetic. They resolved with an oral antibiotic treatment and regular wound dressings using povidone-iodine solution.
Being skeptical at the initial stage, we now recommend the Pneumostat, a pocket-sized Heimlich valve product, to be especially used for this group of young and relatively healthy patients for its safety, effectiveness, and practicality. A precaution with close follow-up may be appropriate in diabetic patients, perhaps with a prophylactic antibiotic cover. As long as patients are well taught how to handle the device and have easy access to the hospital, if necessary, they can recover in their own home.
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Disclosures and Freedom of Investigation
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The Pneumostat used in this study was already purchased by the hospital prior to embarking on its usage and this retrospective review, which was not relevant to any financial gain of any authority or company. We had full control of the design of the study, methods used, outcome measurements, analysis of data, and production of the written report.
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Footnotes
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Disclaimer The Society of Thoracic Surgeons, the Southern Thoracic Surgical Association, and The Annals of Thoracic Surgery neither endorse nor discourage use of the new technology described in this article.
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References
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- Mc Kenna RJ, Fischel RJ, Brenner M, et al. Use to shorten hospital stay after lung reduction surgery for emphysema Ann Thorac Surg 1996;61:1115-1117.[Abstract/Free Full Text]
- Ponn RB, Silverman HJ, Federico JA. Outpatient chest tube management Ann Thorac Surg 1997;64:1437-1440.[Abstract/Free Full Text]
- Mc Manus KG, Spence GM, Mc Guigan JA. Outpatient chest tubes Ann Thorac Surg 1998;66:299-300.[Free Full Text]
- Lodi R, Stefani A. A new portable chest drainage device Ann Thorac Surg 2000;69:998-1001.[Abstract/Free Full Text]
- Cerfolio RJ, Pickens A, Bass C, et al. Fast tracking pulmonary resections J Thorac Cardiovasc Surg 2001;122:318-324.[Abstract/Free Full Text]
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Abstract
Introduction
