What is the basis for treatment selection in pneumothorax?

Updated: Apr 28, 2020
  • Author: Brian J Daley, MD, MBA, FACS, FCCP, CNSC; Chief Editor: Mary C Mancini, MD, PhD, MMM  more...
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Answer

Despite general agreement on the management of pneumothorax, a full consensus about management of initial or recurrent pneumothorax does not exist. Professional societies differ in their approach to management and hospitalization.ref38}

This section presents a risk stratification framework as well as other approaches for choosing among options to restore lung volume and an air-free pleural space and to prevent recurrences. [1] These goals are applicable across diverse clinical presentations. The range of therapeutic options includes watchful waiting with or without supplemental oxygen, simple aspiration, tube drainage with or without medical pleurodesis, video-assisted thoracoscopic surgery (VATS) with pleurodesis and/or closure of leaks and bullectomy, and open surgical procedures such as thoracotomy for pleurectomy or pleurodesis.

Selection between the various management options requires an understanding of the natural history of pneumothorax, the risk of recurrent pneumothorax, and the benefits and limitations of each treatment option and discussion with the patient.

See also Restoring Air-Free Pleural Space in Pneumothorax.


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