Is chest tube drainage losing ground in management of patients with spontaneous pneumothorax?

Needle aspiration should be considered as primary intervention option for stable patients with spontaneous pneumothorax

“…This finding also applied to the 48 patients with secondary pneumothorax. Our results has gained attention, first in an instant editorial in The European Respiratory Journal by Tschopp and Marquette (11), further with interesting comments in the present issue of the Journal of Thoracic Disease by Walker and Maskell (12) from Bristol's expertise on pleural disease, UK , and from a surgeons point of view, Dr. Elsayed (13), Kairo, Egypt.…”

“…Elsayed (13) questions the validity and difference between NA and CTD of the definition of success criteria. By nature these two different treatment approaches cannot possibly have the same definition; simple NA implies immediate withdrawal of equipment, whilst CTD entails continuous drainage over a period of time.…”

Does the Chest Tube Removal Time Influence the Outcomes of Primary Spontaneus Pneumothorax First Episode Management?

“…The main goals in the management of PSP are to re-expand the lung and prevent recurrence, with minimal morbidity [19]. There are different therapeutic options described in literature for managing PSP: observation, air aspiration, placement of the chest tube, pleurodesis, thoracoscopy, and thoracotomy [20][21][22]. Chest tube drainage still remains the main option to manage the first episode of PSP.…”

“…There is a hypothesis that chest tube may irritate the pleural surface and may work like mechanical pleurodesis [14,30,31]. This probably could explain findings in some studies which showed that the recurrence rate after conservative management (without any intervention or only needle aspiration) is higher comparing to chest tube drainage [14,21,22,27].…”

“…Most of the recurrences occur within the first year after the initial episode of PSP [14,16,21]. Olesen et al [14] revealed that 72% of all recurrences occur within the first year, Hofmann et al [16] showed, that two-third of recurrences occur within the first 6 months.…”