Conservative management of spontaneous pneumothorax.

Stradling, Peter; Poole, Graham

doi:10.1136/thx.21.2.145

Cited by 117 publications

(74 citation statements)

References 9 publications

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“…9 This logic has been challenged. 10,11 There are very limited data about outcome for patients with larger PSP treated conservatively; however, success rates of the order 90% have been reported. 10,12,13 Recent studies estimate the rate of re-expansion of PSP at 2.2%/day.…”

Section: Discussionmentioning

confidence: 99%

“…10,11 There are very limited data about outcome for patients with larger PSP treated conservatively; however, success rates of the order 90% have been reported. 10,12,13 Recent studies estimate the rate of re-expansion of PSP at 2.2%/day. 11 Importantly, that study also found significant between and within patient variation in re-expansion rate, with a tendency for larger pneumothoraces to re-expand at a faster rate.…”

Section: Discussionmentioning

confidence: 99%

“…patient still symptomatic) and a volume of < 2.5 L has been aspirated on the first attempt (evidence level B) l If simple aspiration or catheter aspiration drainage of any pneumothorax is unsuccessful in controlling symptoms, then an intercostal tube should be inserted (evidence level B) l There is no evidence that large tubes (20)(21)(22)(23)(24) are any better than small tubes (10)(11)(12)(13)(14) in the management of pneumothoraces. The initial use of large (20)(21)(22)(23)(24) intercostal tubes is not recommended (evidence level B)…”

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Deviation from published guidelines in the management of primary spontaneous pneumothorax in Australia

Kelly

Clooney

2008

Internal Medicine Journal

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Deviation from published guidelines in the management of primary spontaneous pneumothorax in Australia

Kelly

Clooney

2008

Internal Medicine Journal

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“…18 A list of alternative available options for treatment of SP is shown in Table 2. 7 Only one of our 25 patients "forced" a conservative management on us by refusing CTTD, and he did well.…”

Section: Discussionmentioning

confidence: 99%

Spontaneous Pneumothorax: A Retrospective Study of Twenty-Five Patients and Literature Review

et al. 1996

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We present a retrospective study of 25 patients with spontaneous pneumothorax (three recurrent), comprising 16 Saudis (nine males and seven females) and nine non-Saudis (eight males and one female), seen at the Asir Central Hospital, Abha, over a period of 45 months. Almost one-third of the patients (9/25) had no underlying cause discernible by our investigational facilities (chest x-ray, ultrasonography, computed tomographic scan, and flexible bronchofiberscopy). Underlying pneumonia (three patients), pulmonary tuberculosis (two patients), lung abscess (one patient), and congenital bullae (one patient) constituted the etiology in another third of the spontaneous pneumothorax patients. Other underlying pulmonary diseases precipitating spontaneous pneumothorax in the group included pulmonary fibrosis, metastatic mesothelioma, and immunosuppression in a medulloblastoma patient undergoing chemotherapy with the development of chickenpox. Closed thoracostomy tube drainage was the only method of treatment in 20 out of the 25 patients, with three failures of closed thoracostomy tube drainage needing thoracotomy and resection of blebs/bullae. The only complication was empyema in two of the patients. Two patients were successfully treated conservatively with observation alone. Ann Saudi Med 1996;16(3):249-253. A-N Batouk, S Jastaniah, IA Grillo, TS Malatani, AH Al-Saigh, MY Al-Shehri, B Teklu, A Softah, KA Mohmed Ali, Spontaneous Pneumothorax: a Retrospective Study of Twenty-Five Patients and Literature Review. 1996; 16(3): 249-253 The term pneumothorax was introduced almost two centuries ago by Itard in 1803, and popularized by Laennec in 1819.1 From that time until the mid-1930s, it was thought that all pneumothoraces were secondary to pulmonary tuberculosis.2 Kjaergaard's review of the subject in 1932 highlighted the occurrence of the condition in previously healthy individuals.3 If these "healthy individuals" had been thoroughly studied with modern medical, radiological or endoscopic investigations, they might have been found to have such occult abnormalities as blebs, bullae, or bronchial obstructions. 4 The Asir region of Saudi Arabia is a mountainous territory of about one million people, served by the Asir Central Hospital (ACH), a 450-bed tertiary hospital. Over a period of three years and nine months (1990)(1991)(1992)(1993)(1994), 25 patients were treated for spontaneous pneumothorax (SP) at ACH. As this problem has not been previously reviewed in this part of the world, we are presenting the first 25 adult patients of SP seen in this region and reviewing the literature in light of our experience. Patients and MethodsTwenty-five patients with spontaneous pneumothorax (SP) constitute the subjects of this retrospective study (April .1990 to December 1994. The patients consisted of 16 Saudis and nine non-Saudis seen at ACH, either on direct admission through the Emergency Department or upon referral from neighboring hospitals and admitted or evaluated only as outpatients. The demographics (nationality, sex...

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“…With the advent of the chest tube, the use of chest tube drainage (CTD) became widespread although such an approach required hospitalisation and was mainly practised by surgeons [18] and not by pulmonologists. 50 years ago, STRADLING and POOLE [19] had already recommended a conservative and outpatient treatment of pneumothorax. Later on, many randomised studies [20][21][22][23][24][25] proved that simple needle aspiration significantly reduced hospital stay without a higher recurrence rate of pneumothorax, explaining the choice of needle aspiration as a first-line therapy recommended by some guidelines [1,3].…”

Section: @Erspublicationsmentioning

confidence: 99%

Spontaneous pneumothorax: stop chest tube as first-line therapy

Tschopp

Marquette

2017

Eur Respir J

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Spontaneous pneumothorax is traditionally divided between primary spontaneous pneumothorax (PSP) and secondary spontaneous pneumothorax (SSP) when there is some underlying lung disease. For decades management of spontaneous pneumothorax has remained highly debatable despite different published guidelines [1][2][3], many of which contradict each other. Our task force, comprising a multidisciplinary panel of pulmonologists, thoracic surgeons and epidemiologists, recently published a consensus statement [4] on PSP to highlight new findings on the clinical approach, pathophysiology and management strategies of this disease. Pneumothorax remains an under-researched area. The epidemiology of PSP is still poorly documented regarding risk factors or rates of recurrence of PSP. Although smoking remains the principal and well-established risk factor [5], advice for quitting smoking [6] should be routinely given. This disease affects young patients in good health. They are therefore an ideal target population for receiving preventive advice. The pathophysiology of PSP is better understood because of many recent findings. The old concept [7] of PSP because of a localised rupture of a bleb or a bulla is obsolete and has been questioned by many recent studies. We now have robust evidence that the occurrence of PSP is mainly the result of a diffuse histopathological change of the lung parenchyma under the visceral pleura known as emphysema-like changes [8,9]. There is also a diffuse decrease in the lung density measured by computed tomography (CT) [10] and diffuse increased porosity [11] at the periphery of both lungs. These recent findings explain why a localised surgical approach is less effective than a diffuse pleurodesis, whatever the method of pleurodesis used [12,13,14]. Most patients with PSP have no or minimal symptoms, and the entire panel of this European task force [4] agreed that the clinical evaluation of patients with PSP should be more symptom driven and not based only on the measurement of the size of pneumothorax on plain chest radiography or CT, which have little clinical value [15,16]. Tension pneumothorax is very rare [17]. Most patients with spontaneous pneumothorax commonly experience minimal or no symptoms.In recent years, there has been a change in the management strategy of spontaneous pneumothorax leading to more use of a conservative approach [1,3] based on the idea that air in the pleural cavity is well supported. This is not surprising. Chest physicians historically were familiar with inducing artificial pneumothorax in cases of tuberculosis and using the same apparatus for aspirating pneumothorax on an ambulatory basis. With the advent of the chest tube, the use of chest tube drainage (CTD) became widespread although such an approach required hospitalisation and was mainly practised by surgeons [18] and not by pulmonologists. 50 years ago, STRADLING and POOLE [19] had already recommended a conservative and outpatient treatment of pneumothorax. Later on, many randomised studies [20][21][22][23][24...

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Conservative management of spontaneous pneumothorax.

Cited by 117 publications

References 9 publications

Deviation from published guidelines in the management of primary spontaneous pneumothorax in Australia

Deviation from published guidelines in the management of primary spontaneous pneumothorax in Australia

Spontaneous Pneumothorax: A Retrospective Study of Twenty-Five Patients and Literature Review

Spontaneous pneumothorax: stop chest tube as first-line therapy

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