Early referral to a chest physician is encouraged for all patients with ssp, both for management of the pneumothorax and also of the underlying lung disease. In some cases, a computerized tomography ct scan may be needed to provide moredetailed images. Algorithms for the management of spontaneous primary and secondary pneumothorax are shown in. Pneumothorax is generally classified as spontaneous, which occurs without preceding trauma.
At that time, most cases of pneumothorax were secondary to tuberculosis, although some were recognised as occurring in otherwise healthy patients pneumothorax simple. Spontaneous pneumothoraces can be divided into two types. Smoking and the increased risk of contracting spontaneous pneumothorax. Marked practice variation exists in clinicians approaches to the management of primary spontaneous pneumothorax that is partially explained by differences between pulmonologists and surgeons, and also between thoracic and general surgeons. Andrew macduff,1 anthony arnold,2 john harvey,3 on behalf of the bts pleural disease guideline group. It is divided into primary sp psp and secondary sp ssp. The management of spontaneous pneumothorax sp is complicated by the many clinical settings in which it occurs and the lack of accepted guidelines for management. Management of spontaneous pneumothorax postgraduate. Pdf current management of spontaneous pneumothorax.
Diagnosis and management of spontaneous pneumothorax in the. British thoracic society pleural disease guideline 2010 andrew macduff,1 anthony arnold,2 john harvey,3 on behalf of the bts pleural disease guideline group introduction the term pneumothorax was. Owing to better imaging techniques, it is now clear that there is almost no normal visceral pleura in the case of spontaneous pneumothorax, and that blebs and bullae are not. Despite the publication of guidelines controversy over its initial management still exists, particularly over the use of simple aspiration. Bts guidelines for the management of spontaneous pneumothorax pdf thorax. We prospectively assessed the safety and cost saving of a smallbore drain based procedure for outpatient management of first episodes of primary spontaneous pneumothorax. Surgical and nonsurgical management of and selected risk. In this clinical commentary, after a brief discussion of primary and secondary pneumothorax, a summary of the therapeutic options for spontaneous pneumothorax is presented along with recommendations from the. Spontaneous pneumothorax remains a significant problem in the united states. Though the pathogenesis of psp has been gradually uncovered, there is still a lack of consensus in the diagnostic approach and treatment strategies for this disorder. Pdf bts guidelines for the management of spontaneous. A spontaneous pneumothorax is when part of your lung collapses. Decisions for observation, chest tube placement, surgical interventions, and radiographic imaging.
Spontaneous pneumothorax remains a significant health problem. Initial management of spontaneous pneumothorax the. British thoracic society pleural disease guideline 2010. They retrospectively analyzed medical record data from children aged 1 month to 17 years with sp who presented. The management of secondary spontaneous pneumothorax ssp. The trapped air in the pleural space prevents your lung from filling with air, and the lung collapses. Adult patientfocused guidelines british thoracic society 2003 and 2010 introduced aspiration as firstline intervention for primary spontaneous pneumothorax psp and small secondary spontaneous pneumothoraces ssp. The diagnosis of spontaneous nontraumatic pneumothorax has evolved from basic chest radiography to the reference standard. Initial management of spontaneous pneumothorax the lancet. Strong emphasis should be placed on the relationship between the recurrence of pneumothorax and smoking in an effort. Bts guidelines for the management of spontaneous pneumothorax. Traumatic pneumothorax may result from either blunt trauma or penetrating injury to the chest wall. There is a growing consensus that patients with spontaneous pneumothorax can be considered for ambulatory management with the use of a oneway valve. The guideline committee recognized that insufficient.
Spontaneous nontraumatic pneumothorax is a relatively common clinical presentation in the emergency department. A pneumothorax is generally diagnosed using a chest xray. In our current special issue we will present the definition, diagnosis and treatment of pneumothorax from different experts in the field, different countries and present different methods of. We read with interest the article by oliver j bintcliffe and colleagues, who drew attention to controversial issues in the management of spontaneous pneumothorax. A better understanding of the underlying etiology of spontaneous primary pneumothorax has been developing.
Pneumothorax is a common disease worldwide, but surprisingly, its initial management remains controversial. Conclusions despite the overall high rate of success of spontaneous pneumothorax management with the use of adult bts guidelines, this study has shown that needle thoracocentesis is an ineffective management strategy in these paediatric cases, since all patients who underwent needle thoracocentesis required further intervention in the form of tube thoracostomy. Secondary pneumothoraces may be harder to manage and have greater consequences. Traumatic pneumothorax may result from eit her blunt trauma or penetrating injury to the chest wall. There was no significant difference in the other meteorological factors between days with primary spontaneous pneumothorax and days without. Epidemiology and management of primary spontaneous. The recurrence rate was found to average 41 percent.
Principles of diagnosis and management of traumatic pneumothorax anita sharma1, parul jindal1 1departments of postgraduate medicine and anaesthesiology, himalayan institute of medical sciences, dehradun, uttarakhand, india abstract. Investigators in australia and new zealand sought to describe the management of spontaneous pneumothorax sp in children. Ssp is associated with underlying lung diseases such as cystic fibrosis, chronic obstructive pulmonary disease copd, aids, etc. Management of spontaneous pneumothorax sciencedirect. Primary spontaneous pneumothorax psp is a pneumothorax occurring in patients without underlying lung disease and in the absence of provoking factors such as trauma, surgery or mechanical ventilation. Pneumotho rax is classified ethiologically into spontaneous pneu mothorax and traumatic pneumothorax. The use of opinion was made explicit byemploying a structured questionnaire, appropriateness scores, andconsensus scores with a delphi technique.
Small spontaneous pneumothoraces typically resolve without treatment and require only monitoring. Spontaneous pneumothoraces are divided into two types. Spontaneous pneumothorax spontaneous pneumothorax in most patients occurs from the rupture of blebs and bullae. Baumann mh, strange c, heffner je, light r, kirby tj, klein j, luketich jd, panacek ea, sahn sa, aacp pneumothorax consensus group. Introduction the optimal management of pneumothorax remains undefined. In some patients with a large pneumothorax but minimal symptoms conservative management may be appropriate. Management of spontaneous pneumothorax in children. Spontaneous pneumothorax sp is defined as the presence of air in the pleural cavity.
The initial british thoracic society bts guidelines for the treatment of pneumothoraces were published in 1993. Despite this, there is little data on the outcomes of outpatient management of secondary spontaneous pneumothorax ssp. However, our study aimed to establish the current practice of welsh physicians in the management of spontaneous pneumothorax, comparing it with the guidelines published by the british thoracic society bts,11 and highlighting some of the issues around variations from recommended practice. However, with time, there have been improvements in pathogenesis, diagnostic procedures and both medical and surgical approaches to treatment. Management of spontaneous pneumothorax chest journal. The goal in treating a pneumothorax is to relieve the pressure on your lung, allowing it to reexpand. Large observational studies of primary spontaneous pneumothorax have shown that most. Diagnosis and treatment of primary spontaneous pneumothorax. G363p management of paediatric pneumothorax archives. A spontaneous pneumothorax can happen in one or both lungs. Spontaneous pneumothorax occurs in persons who do not have clinically apparent lung disease.
Miller most practising thoracic physicians and surgeons trained in the days when it was accepted that, in all but the most minor cases, patients with spontaneous pneumothorax required removal of intrapleural air as soon as possible, the standard method being intercostal drainage. Principles of diagnosis and management of traumatic. Pdf spontaneous pneumothorax is divided into primary, when there is no underlying lung disease, and secondary, mainly caused by chronic obstructive. Safety and efficacy of ambulatory management of secondary. Primary spontaneous pneumothorax psp commonly occurs in tall, thin, adolescent men. What is the pathophysiology of spontaneous pneumothorax. Primary spontaneous pneumothorax psp is one of the most common thoracic diseases affecting adolescents and young adults. Spontaneous pneumothorax is a significant health problem beca. Its management consists of noninvasive and invasive therapies and it is determined based on clinical manifestations.
Thepreferred management for pneumothorax recurrence prevention is surgical very good consensus because of the lower recurrence rates with theseinterventions compared to the instillation of a sclerosing agentthrough a chest tube. Less invasive management of spontaneous pneumothorax. Objectiveto compare results of surgical versus nonsurgical treatment of spontaneous pneumothorax in dogs designretrospective study animals64 dogs with pneumothorax without any history of antecedent trauma procedureinformation on signalment, thoracic radiographic findings, treatment, histologic findings, and outcome was obtained from the medical records. Otherwise, the insertion of a smallbore chest drain is recommended, a study in ssp 114 having found equivalent success to the use of large drains. Improved imaging modalities and diagnostic approaches have detected evidence of underlying pathologic lung conditions eg, blebs, emphysematouslike changes. Primary in the absence of structural lung disease and secondary in the presence of underlying pulmonary disease, usually copd spontaneous pneumothorax occur in more than 20,000 patients a year in the u. The role of bullae rupture as the cause of air leakage remains unclear, implying that any treatment of psp recurrence includes pleurodesis. Patients were managed by observation alone or insertion of an 8.
Objectives paediatric guidelines are lacking for management of spontaneous pneumothorax. B post operative chest roentgenogram showing expanded lung with autostaples right upper lobe. Chest tube clamping prior its removal is employed by 74% of clinicians. Its management consists of noninvasive and invasive therapies and it is determined based on clinical manifestations, type and size of. The american college of chest physicians compiled an evidencebased consensus statement on the management of this condition. The term pneumothorax was first coined by itard and then laennec in 1803 and 1819 respectively,1 and refers to air in the pleural cavity ie, interspersed between the lung and the chest wall. The management of spontaneous pneumothorax sciencedirect. The guideline was designed tobe relevant to physicians. Epidemiology and management of spontaneous pneumothorax. Pneumothorax is the presence of air in the pleural space. Spontaneous pneumothorax is further classified into primary and secondary. The cause of primary spontaneous pneumothorax is unknown, but established risk factors include male sex, smoking, and a family history of pneumothorax. Pdf diagnosis and management of spontaneous pneumothorax. Itard1 first recognized pneumothorax as a pathological entity and gave it a name in 1803.
Outpatient management of primary spontaneous pneumothorax. Spontaneous pneumothorax represents air trapped within the pleural space that develops without antecedent trauma. Diagnosis and management of spontaneous pneumothorax am fam physician. A preoperative chest roentgenogram showing recurrent right fmeumothorax. Advice from a respiratory physician or surgeon should be sought. Despite the high incidence of psp and the availability of several international guidelines for its diagnosis and treatment, a significant behavioural heterogeneity can be found among those management recommendations.
Paediatric practice is unclear, and evidence for aspiration. Management of spontaneous pneumothorax springerlink. Provide explicit expertbasedconsensus recommendations for the management of adults with primary andsecondary spontaneous pneumothoraces in an emergency department andinpatient hospital setting. Diagnosis and management of spontaneous pneumothorax. Ultrasound imaging also may be used to identify a pneumothorax.
Effectiveness of pneumothorax resolution, duration of and patient tolerance of care, and pneumothorax recurrence. Spontaneous pneumothorax is a common problem in hospital practice. It happens if air collects in the pleural space the space between your lungs and chest wall. Management of spontaneous pneumothorax pleural drains in. Primary spontaneous pneumothorax royal childrens hospital. In this clinical commentary, after a brief discussion of primary and secondary pneumothorax, a summary of the therapeutic options for spontaneous pneumothorax is presented along with recommendations from the writer. Pneumothorax gas in the pleural space can be a lifethreatening condition that needs prompt assessment. Pneumothorax and pneumomediastinum during pediatric mechanical ventilation.
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