From the Guidelines
Drainage of symptomatic pneumothorax, either with needle aspiration or intercostal chest drain attached to an underwater seal, is the current standard of care for spontaneous pneumothorax. The management of pneumothorax depends on the size and cause of the pneumothorax, as well as the severity of symptoms. Small, spontaneous pneumothoraces may resolve without intervention and can be managed with observation, oxygen supplementation, and pain control 1. For larger pneumothoraces or those causing significant symptoms, needle aspiration or chest tube insertion is necessary.
Key Considerations
- The British Thoracic Society guideline recommends drainage of symptomatic pneumothorax, either with needle aspiration or intercostal chest drain attached to an underwater seal, as the current standard of care for spontaneous pneumothorax 1.
- Simple aspiration is recommended as first-line treatment for all primary pneumothoraces requiring intervention, but is less likely to succeed in secondary pneumothoraces 1.
- Large secondary pneumothoraces should be considered a high risk of failure for simple aspiration and recurrence, and therefore tube drainage is recommended as appropriate initial treatment 1.
- Recurrent pneumothoraces may require surgical intervention like pleurodesis or pleurectomy 1.
Management Strategies
- Observation and oxygen supplementation for small, asymptomatic pneumothoraces
- Needle aspiration or chest tube insertion for larger pneumothoraces or those causing significant symptoms
- Tube drainage for large secondary pneumothoraces or those with a high risk of failure for simple aspiration
- Surgical intervention for recurrent pneumothoraces
Patient Care
- Patients should avoid activities that increase intrathoracic pressure during recovery
- Patients should not fly or dive until fully healed
- Patients with secondary pneumothoraces treated successfully with simple aspiration should be admitted to hospital and observed for at least 24 hours before discharge 1.
From the Research
Treatment Options for Pneumothorax
- Needle aspiration (NA) and chest tube drainage (CTD) are two main treatment options for primary spontaneous pneumothorax (PSP) 2, 3, 4, 5.
- Studies have shown that NA and CTD have similar immediate success rates and 12-month recurrence rates 2, 3, 4, 5.
- NA has been found to have a lower complication rate, need for surgical intervention, and shorter hospital stays compared to CTD 2, 3, 4, 5.
Comparison of Needle Aspiration and Chest Tube Drainage
- A meta-analysis of randomized controlled trials found that NA and CTD have similar immediate success rates and 12-month recurrence rates, but NA has a lower complication rate and shorter hospital stays 2.
- Another study found that NA shortened hospital stay and decreased hospitalization rate compared to CTD, but there was no difference in immediate success rate and one-year recurrence rate 3.
- A review of existing evidence found that NA is at least as safe and effective as CTD for management of PSP, with the added benefit of fewer hospital admissions and shorter length of hospital stay 4.
Hospital Stay and Success Rates
- Studies have shown that NA is associated with shorter hospital stays compared to CTD, with a median hospital stay of 2.4 days for NA compared to 4.6 days for CTD 5.
- Immediate success rates have been found to be higher for NA compared to CTD, with a success rate of 69% for NA compared to 32% for CTD 5.
- There is no significant difference in 1-week success rates between NA and CTD 3, 5.
Diagnosis and Assessment
- Early recognition and treatment of pneumothorax are essential in decreasing morbidity and mortality 6.
- Knowledge of the diseases and procedures associated with an increased risk for pneumothorax, as well as the frequent signs and symptoms upon presentation, will assist the clinician in its early identification 6.