LandmarkRCT

OPTICC

OPTICC: A multicentre trial of Occult Pneumothoraces subjected to mechanical ventilation: The final report.

Am J Surg, 2021 · Multicenter randomized trial, underpowered for definitive between-group differences

Population: 142 adults with traumatic occult pneumothorax requiring positive-pressure ventilation
Intervention: Observation with rescue drainage
Comparator: Initial pleural drainage
Primary outcome: Composite respiratory distress
Result: 38% observed versus 25% drained, P=.14; one-quarter failed observation, approaching 40% with ventilation beyond five days.

What the trial found

38% observed versus 25% drained, P=.14; one-quarter failed observation, approaching 40% with ventilation beyond five days.

Clinical interpretation

Observation is an option only for selected stable short-term ventilation with immediate rescue capability. A nonsignificant difference does not prove equivalence; drainage also had complications.

Low certainty

Clinical Context & Relevant Topics (1)

Disease Reference

Pneumothorax & Barotrauma in Critical Care

Tension physiology, point-of-care ultrasound diagnosis, needle/finger/tube thoracostomy, and management of bronchopleural fistulas on mechanical ventilation.

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