Optimal Time of Expansion of Artificial Pneumothorax

A Study of 445 Adequate Pneumothoraces

A study of 445 adequate pneumothorax collapses for pulmonary tuberculosis is presented, considering the cases according to various subdivisions, such as, extent of disease, length of time collapse was maintained, length of follow-up, whether the collapse was discontinued voluntarily or not, and the complications, reactivations and deaths encountered. Data are given on sputum conversion.

Although this was somewhat a picked group of favorable cases, 120 of the 445 adequate pneumothoraces did not reach the point of being voluntarily discontinued. Of these 120 cases, pneumothorax had to be discontinued because of reactivation of disease in 44 (37 per cent), because of complications in 62 cases (52 per cent), because of death in seven cases, and against medical advice in seven cases. These reactivations tended to occur during the first three years of treatment, whereas the complications in the 62 cases tended to develop at any time during treatment. There were 48 cases of nonexpansile lung, with six late reactivations.

From the findings in the 277 cases in which pneumothorax was voluntarily discontinued, it would seem that pneumothorax collapse ot three years or longer gives the best results. Of the 212 voluntarily discontinued cases in which pneumothorax was maintained for three years or longer, 188 (89 per cent) remained arrested at latest date of follow-up. In the 277 voluntarily discontinued pneumothoraces there were 45 reactivations of disease, all but seven of which occurred within the first five years after pneumothorax was discontinued. The occurrence of reactivations dropped from 38 per cent in the group treated for 12 to 23 months to 19 per cent in the group treated for 24 to 35 months and to 12 per cent or less in the cases in which pneumothorax was maintained for three years or longer.

Reactivations which occurred during pneumothorax tended to be on the untreated side, but reactivations which occurred after voluntary discontinuance of pneumothorax were about equal on the side of collapse and on the opposite side.

There were 35 deaths ( 8 per cent) in the 445 adequate pneumothoraces at the time of latest follow-up on these patients-two deaths in the minimal cases, 14 in the moderately advanced, 12 in the far advanced, and seven in the simultaneous bilateral pneumothoraces.