From
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Spontaneous Pneumothorax Rapid Fire: Update Course 2015
Chapter 1 of 3 · Acute Management
Initial management
Initial management of large spontaneous pneumothorax and the thoracentesis-only approach
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Educational content from recorded physician discussions — not medical advice. Talk to your (or your child's) care team about your situation.
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What the experts said
A 50% pneumothorax collapse actually represents 100% collapse because the lung cannot disappear.
One approach is to put in a chest drain, aspirate the air, remove the tube, get an X-ray after 6 hours, and discharge the patient home from the ER without admission.
The recurrence rate after initial pneumothorax treatment is quoted as 30%.
In adult literature, the data does not support high rates of contralateral pneumothorax.
One approach is to obtain CT scan preoperatively, and if blebs are present bilaterally, offer bilateral VATS with pleurodesis at the same operation.
Pleurectomy causes severe postoperative pain, with patients 'climbing out of the hospital.'
Pleurodesis causes significant postoperative pain.
Thoracentesis-only approach (needle aspiration without tube placement) has a surprisingly lower recurrence rate than chest tube placement in the literature.
Talc pleurodesis creates adhesions that make subsequent operations extremely difficult, described as 'like cement.'
A Korean study of 1400 patients across 11 hospitals randomized patients to bleb resection with fibrinogen glue on the staple line versus pleurodesis, showing no difference in recurrence rates.
In the Korean study, at one-year follow-up the fibrinogen glue group had 5.8% recurrence versus 8% recurrence in the pleurodesis group.
A Beijing study of 300 patients comparing pleurodesis versus no pleurodesis showed no difference in recurrence rates.