Update Course Rewind: Spontaneous Pneumothorax 2021

Aspiration can be performed with a needle or with a pigtail catheter less than 12 French.

Conservative management definitions vary: some consider tube thoracostomy as conservative, while current literature defines it as observation with oxygen and pain management without any invasive intervention including needle aspiration or tube thoracostomy.

The Midwest Pediatric Surgery Consortium conducted a multi-center prospective study enrolling 33 children with first presentation of spontaneous pneumothorax, managed with aspiration through a pigtail catheter ≤12 French followed by 6-hour observation with the tube clamped.

In the Midwest Consortium study, 48% of patients were successfully managed with aspiration alone and the rest failed.

Among patients who failed initial aspiration in the Midwest Consortium study, recurrence was 83%.

Of patients successfully managed with aspiration in the Midwest Consortium study, 44% had recurrence.

The Midwest Consortium study authors proposed changing the algorithm to proceed directly to VATS if initial aspiration fails.

The Australia/New Zealand study was a multi-center non-inferiority trial that enrolled 316 patients aged 14-50 years old with moderate to large pneumothoraces (approximately 32% collapse).

In the Australia/New Zealand trial, the success rate was 98.5% in the intervention group versus 94.4% in the observation group.

In the Australia/New Zealand trial, the observation group had lower rates of both adverse events and one-year recurrence compared to the intervention group.

The Australia/New Zealand study demonstrates that even patients with moderate to large spontaneous pneumothoraces can be managed with observation alone.