From the Guidelines
The next step in managing a pneumothorax is to perform drainage of the symptomatic pneumothorax, either with needle aspiration or intercostal chest drain attached to an underwater seal, as recommended by the British Thoracic Society guideline for pleural disease 1.
Procedure:
- For symptomatic pneumothoraces, drainage is the standard of care, with options including needle aspiration or intercostal chest drain attached to an underwater seal.
- The choice between needle aspiration and intercostal chest drain depends on the size of the pneumothorax and the patient's symptoms.
- For small, asymptomatic pneumothoraces, conservative management with observation and serial chest X-rays may be appropriate.
Additional Considerations:
- Provide adequate local anesthesia before insertion of the chest drain or needle aspiration.
- Use sterile technique to prevent infection.
- Monitor vital signs and oxygen saturation closely.
- Administer supplemental oxygen if needed.
- The British Thoracic Society guideline for pleural disease recommends drainage of symptomatic pneumothorax as the standard of care, with options including needle aspiration or intercostal chest drain attached to an underwater seal 1.
- The guideline also notes that ambulatory treatment using a purpose-made device containing a one-way valve, or Heimlich valve attached to chest drain, has the potential to allow outpatient management of pneumothorax.
- Thoracic surgery is often the treatment of choice for ongoing air leak, or for those with recurrent pneumothorax, as it has the potential to reduce the risk of recurrence 1.
From the Research
Management of Pneumothorax
The next step in managing a pneumothorax (collapsed lung) involves several options, including:
- Removing air from the pleural space and providing re-expansion of the lung 2
- Conservative or outpatient management for less severe cases 2
- Simple needle aspiration for primary spontaneous and iatrogenic pneumothoraces 3
- Intercostal chest tube drainage (ICTD) for secondary spontaneous pneumothorax and cases where pleurodesis is indicated 3
Treatment Approaches
Different studies suggest the following treatment approaches:
- Manual aspiration (MA) as a preferred method over tube thoracostomy (TT) in uncomplicated primary spontaneous pneumothorax (PSP) 4
- Needle aspiration (NA) as a simple, safe, and cost-effective method with similar success and recurrence rates to TT 4, 5
- Conservative management through observation or percutaneous pigtail catheter for hemodynamically stable patients with traumatic pneumothorax 6
Comparison of Treatment Methods
Comparing different treatment methods, studies have found: