Pneumothorax

After chest tube placement for pneumothorax, the patient may continue displaying a persistent bronchopleural air leak; what is the initial management?

{{c1::Limit/discontinue PPV}} + {{c1::Remove pleural suction}}

How do these actions help?

{{c1::They reduce the pressure gradient for flow through the bronchopleural fistula}}

 *If these conservative measures fail, next consideration is pleurodesis or "autologous blood patch"

*Can also consider one-way endobronchial valve if air leak location can be found

*The final option is surgical repair

Treatment of pneumothorax depends on its size:

Small (≤2 cm): {{c1::Observation/oxygen}}
Large & stable: {{c1::Needle aspiration +/- chest tube (thoracostomy)}}

{{c1::primary [small 2-cm (oxygen/observation) vs large 2+cm (chest tube/needle decompression) -> definitive procedure IF NOT first episode or PROLONGED PAL, otherwise remove tube/catheter and discharge] vs secondary [chest tube/needle decompression regardless of size -> high risk of persistent air leak (PAL) so VATS/medical thoracoscopy pleurodesis (surgical candidate) vs chemical talc/tetracycline pleurodesis (non-surgical candidate)]}}

What is the initial management for a small (< 2 cm), spontaneous pneumothorax?

{{c1::Observation and supplemental O₂}}

most common in tall, thin, men in their early 20s

oxygen enhances speed of resorption of bleb