Combining all the evidence from the systematic review and these trials, a few consistent points appear to emerge. The vast majority of patients presenting with a primary spontaneous pneumothorax do not need to be hospitalized but can be safely managed as outpatients following initial assessment and interventions, if indicated. If an intervention is necessary, the smallest-bore chest tube is preferred, and this may include a strategy in which a patient is discharged with devices designed for ambulatory management in place. Most important, these data indicate that nonintervention strategy is sound and reasonable in many instances. The pneumothoracies included for evaluation were large, representing nearly 65 percent of the hemithorax, yet still demonstrated uncomplicated recoveries. In an otherwise appropriate patient with a stable, non-enlarging pneumothorax, the best intervention may be the lack thereof.
Explore This IssueACEP Now: Vol 39 – No 10 – October 2020
The opinions expressed herein are solely those of Dr. Radecki and do not necessarily reflect those of his employer or academic affiliates.
- Mummadi SR, de Longpre J, Hahn PY. Comparative effectiveness of interventions in initial management of spontaneous pneumothorax: a systematic review and a Bayesian network meta-analysis. Ann Emerg Med. 2020;76(1):88-102.
- Brown SGA, Ball EL, Perrin K, et al. Conservative versus interventional treatment for spontaneous pneumothorax. N Engl J Med. 2020;382(5):405-415.
- Hallifax RJ, McKeown E, Sivakumar P, et al. Ambulatory management of primary spontaneous pneumothorax: an open-label, randomised controlled trial. Lancet. 2020;396(10243):39-49.
- MacDuff A, Arnold A, Harvey J, et al. Management of spontaneous pneumothorax: British Thoracic Society Pleural Disease Guideline 2010. Thorax. 2010;65 Suppl 2:ii18-31.