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Pneumothorax
This document discusses the management of spontaneous pneumothorax according to British Thoracic Society guidelines. It covers topics such as the use of chest tubes and suction, management of bronchopleural fistulas, indications for surgical consultation, post-treatment advice, and tension pneumothorax. Management involves chest tube drainage and observation for most cases, while refractory air leaks, bilateral pneumothorax, or high-risk professions may require surgical intervention or advice.
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Pneumothorax
- 1. Spontaneous Pneumothorax By: Dr. Ismah Reference:Management of spontaneous pneumothorax, British Thoracic Society pleural disease guideline 2010 06/08/2014 1
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- 7. Suction • Not routinelyused because may cause re expansion pulmonary edema • Indicated when persistent air leak with or without incomplete re-expansion of the lung after 48 hrs • High-volume low-pressure systems such as Vernon-Thompson pumps or wall suction with low pressure adaptors 06/08/2014 7
- 8. Bronchopleural fistula • Communicationbetween the bronchial tree and pleural space. • Persistent air leak or a failure to re-inflate the lung despite chest tube drainage for 24 h. • Chest drains inserted into the lung parenchyma • Management: - Large bore chest drains (multiple if necessary) and the use of drainage system - Refractory cases surgical repair of the air leak by thoracoplasty, lung resection/stapling, pleural abrasion/decortication 06/08/2014 8
- 9. Thoracic surgeon Indications forsurgical advice: • Persistent air leak (despite 5 to 7 days of chest tube drainage) or failure of lung re-expansion. • Synchronous bilateral spontaneous pneumothorax. • Professions at risk (eg, pilots, divers). • Pregnancy. • Second ipsilateral pneumothorax. • First contralateral pneumothorax. • Spontaneous haemothorax 06/08/2014 9
- 10. Advice & f/up •Avoid air travel until 1 weeks post fully resolution • Avoid diving unless has undergone bilateral surgical pleurectomy and has normal lung function and chest CT scan postoperatively • Observation/ NA F/up in 2-4 weeks 06/08/2014 10
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Editor's Notes
- #3 PSP & SSP SSP associated with lung disease e.g. TB, COAD & symptoms more severe than PSP Size of pneumothorax not determine the severity of symptoms Tension pneumothorax cardiorespiratoy distress i.e. cyanosis, sweating, severe tachypnoea, tachycardia and hypotension Pneumothorax – erect inspiratory PA cxr displacement of pleural line CT scan for small pneumothorax
- #4 PSP Male, young, tall & thin
- #5 PSP referral to chest physician in 24hr, ref to thoracic surgeon if persistent air leak in 5-7 days chest tube SSP early referral, d/w thoracic surgeon if persistent air leak in 48 hrs Surgical empysema?
- #6 The size of the pneumothorax determines the rate of resolution and is a relative indication for active intervention. Best measured by Digital radiography (Picture-Archiving Communication Systems, PACS)
- #8 Chemical plerodesis – sclerosing agent e.g. tetracycline open or VATS approach
- #10 AIM: resect any visible bullae or blebs on the visceral pleura and also to obliterate emphysema-like changes9 or pleural porosities under the surface of the visceral pleura.8 The second objective is to create a symphysis between the two opposing pleural surfaces as an additional means of preventing recurrence 1. Open thoracotomy and pleurectomy remain the procedure with the lowest recurrence rate (approximately 1%) for difficult or recurrent pneumothoraces. (A) 2. Video-assisted thoracoscopic surgery (VATS) with pleurectomy and pleural abrasion is better tolerated but has a higher recurrence rate of approximately 5%. (A) 3. Surgical chemical pleurodesis is best achieved by using 5 g sterile graded talc, with which the complications of adult respiratory distress syndrome and empyema are rare.