Consensus StatementsManagement of Spontaneous Pneumothorax
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| Pneumothorax type | Clamp chest tube and monitor for pneumothorax recurrence | Not clamp chest tube; stop suction, continue water seal or Heimlich valve, and repeat chest radiograph at a later time; if no pneumothorax recurrence, pull chest tube | Pull chest tube now and repeat a chest radiograph |
|---|---|---|---|
| Primary*: Your next step? | Indeterminate† (SC)‡ | Preferred management (G) | Acceptable rarely (G) |
| Secondaryõ: Your next step? |
Indeterminate (SC) | Preferred management (G) | Acceptable rarely (VG) |
| Pneumothorax type | Would never clamp a chest tube in this setting | Assuming one clamps a chest tube, how may hours should one wait before clamping? (How long after one first notes airleak ceased should one wait before clamping?) | Whether utilizing a clamp or observation to ensure no airleak: How many hours should one wait from the time airleak stops before removing the chest tube assuming a repeat chest radiograph shows no pneumothorax? |
|---|---|---|---|
| Primary*: Your next step? | 53% of expert respondents | Median: <4 h 50% rangeÛ: <=4 h |
Median: 5 to12 h 50% range: 5 to 23 h |
| Secondaryõ: Your next step? |
41% of expert respondents | Median: 5 to 12 h 50% range: 5 to 12 h |
Median: 13 to 23 h 50% range: 13 to 23 h |
| *Young previously healthy patient with chest tube present for 2 days. Airleak stopped this morning. Chest radiograph shows no pneumothorax. †See Table 5—Management Definitions. ‡Levels of consensus (Table 4) appear in parenthesis after option: P = perfect, VG = very good, G = good, SC = some consensus, NC = no consensus. Û50% range is interquartile range around the median (middle 50% of respondents) õ55-year-old patient with COPD with chest tube present for 2 days. Airleak stopped this morning. Chest radiograph shows no pneumothorax. |
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