What is the role of thoracostomy in the management of 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

First-time secondary spontaneous pneumothorax (SPS) (including chronic obstructive pulmonary disease [COPD]) and traumatic pneumothorax typically require this approach. A small-bore catheter (eg, 7-14 French) is safe to use in most patients, whereas a larger chest tube (24 French) is also appropriate initially, and increasing suction pressure can be used if the lung fails to inflate.

A larger tube (eg, 28 French) can reduce resistance in patients who are ventilated and at greater risk for air leaks. Air leaks resolve within 7 days of treatment 80% of the time, with an average hospital stay of 5 days. Keep the tube in place for 24 hours after the air leak ceases.


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