Effectiveness and safety of conservative management of occult pneumothorax in mechanically ventilated patients: a systematic review protocol

Abstract

OBJECTIVE: This systematic review aims to synthesize the available evidence investigating the effectiveness and safety of conservative management of occult pneumothorax in mechanically ventilated patients. INTRODUCTION: Occult pneumothorax is air within the pleural cavity that is diagnosed on a CT scan but was not suspected on the basis of preceding clinical examination or supine chest x-ray. Currently, there is no consensus on how to manage occult pneumothoraces, especially in patients requiring mechanical ventilation. It is common practice to place a prophylactic intercostal catheter (ICC) to stop the potential development of a tension pneumothorax; however, there is a 20% risk of major complications from the ICC insertion. Recent evidence suggests that occult pneumothorax in mechanically ventilated patients can be managed conservatively, rather than using a prophylactic ICC as first-line management. INCLUSION CRITERIA: This review will include studies investigating stable patients of all ages who were diagnosed with traumatic occult pneumothorax via CT scan, received mechanical ventilation, and underwent either conservative management or ICC insertion. METHODS: Eligible studies will include randomized and non-randomized controlled trials, and prospective and retrospective cohort studies. PubMed, Embase, CINAHL, Web of Science and Cochrane Central Register of Controlled Trials will be searched. International Clinical Trials Registry, Australian New Zealand Clinical Trials Registry and ClinicalTrials.gov will be searched for unpublished studies. All included studies will be critically appraised using standardized JBI tools, with no exclusions based on methodological quality. Studies will, where possible, be pooled in statistical meta-analysis, with impact of methodological quality to be explored through sensitivity analysis.