From the Guidelines
The current management of secondary spontaneous pneumothorax (SSP) typically involves hospitalization and chest tube insertion for most patients, as these pneumothoraces tend to be more dangerous than primary spontaneous pneumothoraces due to underlying lung disease. For small, asymptomatic SSPs (less than 2 cm or 15% of the hemithorax), observation with supplemental oxygen may be appropriate with close monitoring 1. However, for larger or symptomatic SSPs, chest tube drainage is recommended, typically using small-bore catheters connected to a Heimlich valve or underwater seal system 1. The chest tube should remain in place until the air leak resolves and the lung fully expands, usually 3-5 days. Persistent air leaks (beyond 3-5 days) may require surgical intervention, with video-assisted thoracoscopic surgery (VATS) being the preferred approach for pleurodesis or surgical repair 1. Chemical pleurodesis with agents like talc or doxycycline can be considered for patients who are poor surgical candidates. Recurrence prevention is crucial, with definitive interventions like pleurodesis or pleurectomy recommended after the first episode in most SSP patients due to high recurrence rates. Throughout management, adequate pain control with acetaminophen, NSAIDs, or opioids as needed, and pulmonary rehabilitation addressing the underlying lung disease are essential components of comprehensive care. Some key considerations in the management of SSP include:
- The size and symptoms of the pneumothorax, with larger or symptomatic pneumothoraces requiring more aggressive treatment 1
- The underlying lung disease, with patients having more advanced lung disease requiring more intensive management 1
- The risk of recurrence, with definitive interventions recommended after the first episode in most SSP patients 1
From the Research
Current Guidance for Secondary Spontaneous Pneumothorax Management
- The current guidance for managing secondary spontaneous pneumothorax (SSP) emphasizes the need for effective and efficient treatment to reduce morbidity, mortality, and hospital admissions 2.
- Recent studies have explored the use of ambulatory management for SSP, including the use of one-way flutter valves, as a potential alternative to traditional intercostal chest tube management 3, 4.
Ambulatory Management of Secondary Spontaneous Pneumothorax
- A randomized controlled trial found that ambulatory care with a flutter valve did not significantly reduce the length of stay compared to standard care with a chest tube and underwater seal 3.
- However, the study noted that patients treated with an Atrium Pneumostat valve had no early treatment failures and a trend towards lower length of stay, suggesting that this type of valve may be a safer alternative for ambulatory management 3.
- Another study found that pigtail catheter drainage was effective in treating SSP associated with obstructive lung conditions and malignancy, but had a higher rate of treatment failure in patients with infectious diseases 5.
Safety and Efficacy of Ambulatory Management
- A case series study found that ambulatory management of SSP using a one-way valve was safe and effective, with similar outcomes to primary spontaneous pneumothorax (PSP) patients 4.
- The study also reported significant cost savings associated with ambulatory management, with an estimated £86,796 saved over the study period 4.
- Overall, the current evidence suggests that ambulatory management of SSP may be a viable option for selected patients, but further research is needed to determine the optimal management strategy for this condition 2, 3, 4.