Spontaneous Pneumothorax Treatment Options
Primary pneumothorax
Observation is the treatment of choice for a small PSP without significant breathlessness.
Patients can be considered for discharge with early outpatient review providing they can easily seek medical attention in the event of worsening breathlessness.
Needle/cannula aspiration (14-16G) is the treatment of choice in a haemodynamically stable patient with a large PSP or small PSP in a patient who is symptomatic. It has been shown to be as safe and effective as chest tube placement with the additional benefits of shorter length of stay and fewer hospital admissions.
Aspirate under Local anaesthetic until resistance is felt, the patient coughs excessively or once 2.5litres have been withdrawn.
These patients should receive a repeat CXR after aspiration and a period of observation. There is no definite period of how long they need to be observed for but if the patient remains symptom free with a resolved or only small pneumothorax, then a period of 2-6 hours depending on circumstances would be adequate.
Following failed NA, small bore ( is recommended with admission.
Secondary pneumothorax
All SSP require admission.
A large or symptomatic SSP requires small bore chest drain as first line treatment.
If a small SSP then aspiration can be attempted first. If this reduces the size to
BTS guidelines for the management of spontaneous pneumothorax
Tips
If a patient is hospitalised for observation, supplemental high flow oxygen should be given. This treats possible hypoxaemia but has also been shown to result in a four-fold increase in rate of pneumothorax resolution.
Suction should not be routinely employed as there is a risk of Re-expansion pulmonary oedema (RPO) due to the often delayed presentation. When used high volume low pressure suction systems are recommended.
Rate of resolution of pneumothorax is between 1.25% and 2.2% every 24hrs. Thus a complete pneumothorax may take up to 6 weeks to resolve spontaneously.
Resources
- See our procedures page for needle decompression of the chest and pleural drains