HWN Suggests

What’s the Best Intervention for Primary Spontaneous Pneumothorax?

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…

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Articles of Interest

Conservative management of pneumothoraces

Conservative management of moderate and large spontaneous pneumothoraces is an option...

Conservative treatment for primary spontaneous pneumothorax

A new paper was published this month that is likely to change the way that a lot of people manage spontaneous pneumothorax (although I don’t think it will significantly change my practice)…

Spontaneous Pneumothorax: Stand There and Do Nothing?

In a select and carefully identified subset of patients with large primary spontaneous pneumothorax in a clinical setting that can accommodate both observation and potential emergent intervention, a conservative management approach of observation may obviate the need for chest tubes. For many clinicians, this strategy may not be feasible. The authors of this trial have posed a critical question and laid the foundation for a shift in the management of larger primary spontaneous pneumothoraces.

The RAMPP Trial: Randomised Ambulatory Management of Primary Pneumothorax

The increased risk of serious adverse events and the need for repeated close outpatient follow-up by a clinician trained to manage pneumothoraces and chest drains in the ambulatory cohort seem too much to overcome for most patients and clinicians. However, it may be a viable option for some with careful selection and shared decision-making. Perhaps a better strategy is to apply O2 and repeat CXR in 4 hours before attempting any invasive procedure.

Update: Is Needle Aspiration Better Than Chest Tube Placement for the Management of Primary Spontaneous Pneumothorax?

Chest tube placement is successful more often than needle aspiration in the treatment of primary spontaneous pneumothorax, yet is associated with longer hospital length of stay and potentially more adverse events. Therefore, both needle aspiration and chest tube placement are reasonable first-line options, depending on individual patient preferences and circumstances.