Consensus StatementsManagement of Spontaneous Pneumothorax
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| Pneumothorax type | Time to monitor airleak? (Days to monitor chest tube drainage before proceeding to an intervention to stop the leak assuming immediate availability of all interventional options) |
|---|---|
| Primary * | Median: 4 days 50% range†: 3 to 5 days 80% range†: 2 to 6 days |
| Secondaryõ | Median: 5 days 50% range: 4 to 7 days 80% range: 2 to 7 days |
| Airleak interventional options | |
|---|---|
| Chemical sclerosis through the chest tube | Place an additional chest tube |
| Acceptable rarely‡ (VG)Û | Inappropriate (VG) |
| Certain circumstances (G) | Inappropriate (VG) |
| Pneumothorax type | Airleak interventional options | |
|---|---|---|
| Fiberoptic bronchoscopy–directed localization of airleak with bronchoscopy directed application of airleak sealant such as doxycycline | Surgical approach (eg, thoracoscopy, thoracotomy) | |
| Primary * | Inappropriate (VG) | Preferred management (VG)|| |
| Secondaryõ | Inappropriate (VG) | Preferred management (VG)|| |
| *Young previously healthy patient with a chest tube has a persistent airleak and the lung is reexpanded by chest radiograph. †50% range is interquartile range or respondents around the median (middle 50% of respondents); 80% range is middle 80% of respondents around the median. ‡See Table 5—Management Definitions. ÛLevels of consensus (Table 4) appear in parenthesis after option: P = perfect, VG = very good, G = good, SC = some consensus, NC = no consensus. ||Majority of respondents (>75%): thoracoscopic approach. 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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