Observation is appropriate for patients with an asymptomatic, first-time primary spontaneous pneumothorax that occupies less than 20% of the hemithorax; supplemental oxygen may be added to hasten the absorption of the pleural gas. Patients with symptoms or whose pneumothorax is greater than 20% require either catheter aspiration or long-term placement of an indwelling catheter or chest tube. Refer patients who have persistent air leaks for more than 72 hours for surgery; options include video-assisted thoracoscopic surgery and open thoracotomy. Most pneumothoraces in patients with chronic obstructive pulmonary disease (COPD) require long-term aspiration. In addition, chemical pleurodesis is recommended once the air leak has resolved. Consider surgery if the COPD is severe, the pneumothorax is poorly tolerated, or the air leak persists longer than 72 hours. When tension pneumothorax is suspected, immediate decompression using a large-bore needle placed into the second anterior intercostal space is required; this is followed by tube thoracostomy.
|Original language||English (US)|
|Number of pages||7|
|State||Published - Sep 1 1998|
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