Management of pneumothorax: an update.

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Alejandro Aragaki-Nakahodo

Author Information

Alejandro Aragaki-Nakahodo: Director of Interventional Pulmonology, Pulmonary and Critical Care Medicine Division, University of Cincinnati, Cincinnati, Ohio, USA.

PMID: 34857696 DOI: 10.1097/MCP.0000000000000839

PURPOSE OF REVIEW: Pneumothorax is a global health problem. To date, there is still significant variation in the management of pneumothorax. For the past few years, there have been significant developments in the outpatient management of both primary and secondary spontaneous pneumothorax (SSP). We will review the latest evidence for the management of nontraumatic pneumothorax (spontaneous and iatrogenic) to include pneumothorax associated with COVID-19 infection.
RECENT FINDINGS: Outpatient management of both primary and SSP may be safe and feasible.
SUMMARY: Outpatient management of both primary and SSP should be included in treatment options discussion with patients.

Baumann MH, Strange C, Heffner JE, et al. Management of spontaneous pneumothorax. An American College of Chest Physicians Delphi Consensus Statement. Chest 2001; 119:590–602.
MacDuff A, Arnold A, Harvey J, et al. Management of spontaneous pneumothorax: British Thoracic Society Pleural Disease Guideline. Thorax 2010; 65: (Suppl 2): ii18–ii31.
Tschopp JM, Bintcliffe O, Astoul P, et al. ERS task force statement: diagnosis and treatment of primary spontaneous pneumothorax. Eur Respir J 2015; 46:321–335.
Schnell J, Beer M, Eggeling S, et al. Management of spontaneous pneumothorax and post-interventional pneumothorax: German S3 Guideline. Respiration 2019; 97:370–402.
Hallifax RJ, Janssen JP. Pneumothorax – time for new guidelines? Semin Respir Crit Care Med 2019; 40:314–322.
Collins CD, Lopez A, Mathie A, et al. Quantification of pneumothorax size on chest radiographs using interpleural distances: regression analysis based on volume measurements from helical CT. AJR 1995; 165:1127–1130.
Plojoux J, Froudarakis M, Janssens JP, et al. New insights and improved strategies for the management of primary spontaneous pneumothorax. Clin Respir J 2019; 13:195–201.
Brown SGA, Ball EL, Perrin K, et al. Conservative versus interventional treatment for spontaneous pneumothorax. N Engl J Med 2020; 382:405–415.
Hallifax RJ, Psallidas I, Rahman NM. Chest drain size: the debate continues. Curr Pulmonol Rep 2017; 6:26–29.
Chang SH, Kang YN, Chiu HY, et al. A systematic review and meta-analysis comparing pigtail catheter and chest tube as the initial treatment for pneumothorax. Chest 2018; 153:1201–1212.
Carson-Chahhoud KV, Wakai A, Van Agteren JEM, et al. Simple aspiration versus intercostal tube drainage for primary spontaneous pneumothorax in adults. Cochrane Database System Rev 2017; Issue 9.
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; 76:88–102.
Tan J, Chen H, He J, et al. Needle aspiration versus closed thoracostomy in the treatment of spontaneous pneumothorax: a meta-Analysis. Lung 2020; 198:333–344.
Walker SP, Bibby AC, Halford P, et al. Recurrence rates in primary spontaneous pneumothorax: a systematic review and meta-analysis. Eur Respir J 2018; 52:1800864.
Sudduth CL, Shinnick JK, Geng Z, et al. Optimal surgical technique in spontaneous pneumothorax: a systematic review and meta-analysis. J Surg Res 2017; 210:32–46.
Vuong NL, Elshafay A, Thao LP, et al. Efficacy of treatments in primary spontaneous pneumothorax: a systematic review and network meta-analysis of randomized controlled trials. Respir Med 2018; 137:152–166.
Ali JM, Aresu G. Is it time to reconsider the need for bullectomy in the surgical management of primary spontaneous pneumothorax? J Thorac Dis 2020; 12:3921–3923.
Olesen WH, Katballe N, Sindby JE, et al. Surgical treatment versus conventional chest tube drainage in primary spontaneous pneumothorax: a randomized controlled trial. Eur J Cardiothorac Surg 2018; 54:113–121.
Liu YW, Chang PC, Chang SJ, et al. Simultaneous bilateral thoracoscopic blebs excision reduces contralateral recurrence in patients undergoing operation for ipsilateral primary spontaneous pneumothorax. J Thorac Cardiovas Surg 2020; 159:1120–1127.
Jouneau S, Vuillard C, Sale A, et al. Outpatient management of primary spontaneous pneumothorax. Respir Med 2021; 176:106240.
Hallifax RJ, McKeown E, Sivakamur P, et al. Ambulatory management of primary spontaneous pneumothorax: an open-label, randomised controlled trial. Lancet 2020; 396:39–49.
Tschopp JM, Rami-Porta R, Noppen M, et al. Management of spontaneous pneumothorax: state of the art. Eur Respir J 2006; 28:637–659.
Ichinose J, Nagayama K, Hino H, et al. Results of surgical treatment for secondary spontaneous pneumothorax according to underlying diseases. Eur J Cardiothorac Surg 2016; 49:1132–1136.
Wang Y, Abougergi MS, Li S, et al. Recurrence prophylaxis in secondary spontaneous pneumothorax. a nationwide readmission database analysis. Chest 2020; 158:2474–2484.
Walker SP, Keenan E, Bintcliffe O, et al. Ambulatory management of secondary spontaneous pneumothorax: a randomised controlled trial. Eur Respir J 2021; 57:2003375.
Martinelli AW, Ingle T, Newman J, et al. COVID-19 and pneumothorax: a multicentre retrospective case series. Eur Respir J 2020; 56:2002697.
Elder C, Bawa S, Anderson D, et al. Expectant management of pneumothorax in intubated COVID-19 positive patients: a case series. J Cardiothorac Surg 2020; 15:263.

COVID-19

Humans

Pneumothorax

SARS-CoV-2

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