Pneumothorax—Time for New Guidelines?

Rob Hallifax, DPhil, MRCP, BMCh; Julius P. Janssen, MD, PhD


Semin Respir Crit Care Med. 2019;40(3):314-322. 

In This Article


Current guidelines recommend NA prior to chest drain insertion for PSP, but that SSP should be treated with chest drain. The results of recently completed trials in conservative and ambulatory management are eagerly awaited. Clinicians should be vigilant for PSP being the first manifestation of a systemic disease, and should have a low threshold for onward referral and CT scan evaluation of the lung parenchyma. Future studies should utilize risk stratification by clinical and radiological parameters (e.g., HRCT scanning and digital air leak monitoring) to predict short- and long-term outcomes, and hence personalize management. The focus of treatment should move to outpatient management whenever possible, especially when no intervention to prevent recurrence is performed.