Heimlich Valve in the Management of Pneumothorax in Patients With Advanced AIDS

To review therapeutic strategies inthe management of pneumothorax in patients with AIDS. Retrospective, 7-year, single institutionexperience. Forty-seven patients with AIDSwere treated for 59 pneumothoraxes. Mean age was 37.4 years, and 70%of patients had prior or current infection with Pneumocystiscarinii. All patients had CD4+ counts of < 100, and 28 of 47patients (59.6%) had CD4+ counts of < 50. Of 59 pneumothoraxes, 14pneumothoraxes (23.7%) were iatrogenic and 16 pneumothoraxes (27.1%)were bilateral. Patients were treated with conventional strategy (tubethoracostomy [TT] with or without pleurodesis, thoracotomy withblebectomy) or converted to a Heimlich valve (HV) in case of failure ofconventional management. Thirty-six of 47patients (76.6%) were discharged, and only 26 of 36 patients (72.2%)had complete pneumothorax resolution at discharge after conventionaltreatment. All patients discharged with an HV (10 of 36 patients;27.8%) had pneumothorax resolution followed by valve removal asoutpatients. Mean hospital stay after chest decompression was 12 daysfor conventional-therapy group survivors and 3 days for patientstreated with an HV. Thirteen patients died (27.7%) with follow-up to60 days. In-hospital mortality was 23.4% (11 of 47 patients), whichrepresented a 29.7% mortality for patients treated with conventionaltherapy. Patients treated with an HV had no in-hospital mortality and100% pneumothorax resolution, with two deaths occurring within 60 daysof discharge but after removal of the HV. Patients with advanced AIDS and pneumothorax have high associatedmorbidity and mortality. If no resolution is observed after simple TT, prompt conversion to an HV allows safe and early hospitaldischarge.