Journal Information
Vol. 44. Issue 8.
Pages 437-448 (January 2008)
Share
Share
Download PDF
More article options
Vol. 44. Issue 8.
Pages 437-448 (January 2008)
Recommendations of the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR)
Full text access
Guidelines for the Diagnosis and Treatment of Spontaneous Pneumothorax
Visits
36777
Juan J. Rivas de Andrésa,
Corresponding author
jjrivas@jet.es

Correspondence: Dr. J.J. Rivas Servicio de Cirugía Torácica de Aragón Hospital Universitario Miguel Servet Paseo de Isabel la Católica, 1-3 50009 Zaragoza, Spain Correo electrónico
, Marcelo F. Jiménez Lópezb, Laureano Molins López-Rodóc, Alfonso Pérez Trullénd, Juan Torres Lanzase
a Servicio de Cirugía Torácica de Aragón, Hospital Universitario Miguel Servet, Zaragoza, Spain
b Servicio de Cirugía Torácica, Hospital Universitario, Salamanca, Spain
c Servicio de Cirugía Torácica, Hospital Universitari Sagrat Cor, Barcelona, Spain
d Servicio de Neumología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
e Servicio de Cirugía Torácica, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
This item has received
Article information
Abstract
Bibliography
Download PDF
Statistics

This is the fourth update of the guidelines for the diagnosis and treatment of pneumothorax published by the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR).

Spontaneous pneumothorax, or the presence of air in the pleural space not caused by injury or medical intervention, is a significant clinical problem. We propose a method for classifying cases into 3 categories: partial, complete, and complete with total lung collapse. This classification, together with a clinical assessment, would provide sufficient information to enable physicians to decide on an approach to treatment.

This update introduces simple aspiration in an outpatient setting as a treatment option that has yielded results comparable to conventional drainage in the management of uncomplicated primary spontaneous pneumothorax; this technique is not, as yet, widely used in Spain.

For the definitive treatment of primary spontaneous pneumothorax, the technique most often used by thoracic surgeons is video-assisted thoracoscopic bullectomy and pleural abrasion.

Hospitalization and conventional tube drainage is recommended for the treatment of secondary spontaneous pneumothorax.

This update also has a new section on catamenial pneumothorax, a condition that is probably underdiagnosed.

The definitive treatment for a recurring or persistent air leak is usually surgery or the application of talc through the drainage tube when surgery is contraindicated.

Our aim in proposing treatment algorithms for the management of pneumothorax in these guidelines was to provide a useful tool for clinicians involved in the diagnosis and treatment of this disease.

Key words:
Spontaneous pneumothorax
Bullae
simple aspiration
Chest drainage
Video-assisted thoracoscopy
Treatment

Se presenta la cuarta puesta al día de la “Normativa sobre diagnóstico y tratamiento del neumotórax”, de la Sociedad Española de Neumología y Cirugía Torácica (SEPAR).

La presencia de aire dentro de la cavidad pleural de causa no traumática o iatrógena es un problema clínico relevante. Se propone un método de cuantificación del neumotórax mediante su clasificación en parcial, completo o total, que junto a la valoración clínica parece suficiente para adoptar las diversas actitudes terapéuticas.

En la presente actualización se incorpora la aspiración simple ambulatoria, como método equiparable en resultados al drenaje convencional, para el tratamiento del neumotórax espontáneo primario no complicado, cuyo uso no está todavía muy extendido en España.

Para el tratamiento definitivo del neumotórax espontáneo primario, la cirugía videotoracoscópica con bullectomía y abrasión pleural es la técnica más ampliamente utilizada por la mayoría de cirujanos torácicos.

En el tratamiento del neumotórax espontáneo secundario se recomienda el ingreso y la colocación de drenaje torácico convencional.

Se ha introducido también una referencia al neumotórax catamenial, probablemente infradiagnosticado.

En caso de recidiva o fuga aérea persistente, el tratamiento definitivo suele ser el quirúrgico o el uso de talco a través del drenaje en caso de contraindicación.

Los algoritmos de estrategia terapéutica aquí propuestos pretenden convertirse en una herramienta de trabajo útil para todos los implicados en el diagnóstico y tratamiento de esta enfermedad.

Palabras clave:
Neumotórax espontáneo
Bullas
Aspiración simple
Drenaje torácico
Videotoracoscopia
Tratamiento
Full text is only aviable in PDF
References
[1]
D Gupta, A Hansell, T Nichols, T Duong, JG Ayres, D Strachan.
Epidemiology of pneumothorax in England.
Thorax, 55 (2000), pp. 666-671
[2]
A Henry, T Arnold, J Harvey.
BTS guidelines for the management of spontaneous pneumothorax.
Thorax, 58 (2003), pp. 39-52
[3]
LJ Melton, NGG Hepper, KP Offord.
Incidence of spontaneous pneumothorax in Olmsted Country, Minnesota: 1950–1974.
Am Rev Respir Dis, 120 (1979), pp. 1379-1382
[4]
L Bense, G Eklund, LG Wiman.
Smoking and the increased risk of contracting spontaneous pneumothorax.
Chest, 92 (1987), pp. 1009-1012
[5]
FM Schramel, PE Postmus, RG Vanderschueren.
Current aspects of spontaneous pneumothorax.
Eur Respir J, 10 (1997), pp. 1372-1379
[6]
HL Lippert, O Lund, S Blegvad, HV Larsen.
Independent risk factors for cumulative recurrence rate after first spontaneous pneumothorax.
Eur Respir J, 4 (1991), pp. 324-331
[7]
V Videm, J Pillgram-Larsen, O Ellingsen, G Andersen, E Ovrum.
Spontaneous pneumothorax in chronic obstructive pulmonary disease: complications, treatment and recurrences.
Eur J Respir Dis, 71 (1987), pp. 365-371
[8]
MH Baumann.
Management of spontaneous pneumothorax.
Clin Chest Med, 27 (2006), pp. 369-381
[9]
RT Sadikot, T Greene, K Meadows, AG Arnold.
Recurrence of primary spontaneous pneumothorax.
Thorax, 52 (1997), pp. 805-809
[10]
VM Voge, R Anthracile.
Spontaneous pneumothorax in the USAF aircrew population: a retrospective study.
Aviat Space Environ Med, 57 (1986), pp. 939-949
[11]
SA Sahn, JE Heffner.
Spontaneous pneumothorax.
N Engl J Med, 342 (2000), pp. 868-874
[12]
RW Light.
Management of spontaneous pneumothorax.
Am Rev Respir Dis, 148 (1993), pp. 245-248
[13]
V Cottin, N Streichenberger, JP Gamondes, F Thevenet, R Loire, JF Cordier.
Respiratory bronchiolitis in smokers with spontaneous pneumothorax.
Eur Respir J, 12 (1998), pp. 702-704
[14]
HJM Smit, M Chatrou, PE Postmus.
The impact of spontaneous pneumothorax and its treatment on the smoking behaviour of young adult smokers.
Respir Med, 92 (1998), pp. 1132-1136
[15]
HJ Smit, WL Deville, FM Schramel, JM Schreurs, TG Sutedja, PE Postmus.
Atmospheric pressure changes and outdoor temperature changes in relation to spontaneous pneumothorax.
Chest, 116 (1999), pp. 676-681
[16]
M Noppen, S Verbanck, J Harvey, R Van Herreweghe, M Meysman, W Vincken, et al.
Music: a new cause of primary spontaneous pneumothorax.
Thorax, 59 (2004), pp. 722-724
[17]
MH Baumann.
Do blebs cause primary spontaneous pneumothorax? Pro: Blebs do cause primary spontaneous pneumothorax.
J Bronchol, 9 (2002), pp. 313-318
[18]
M Noppen.
Do blebs cause primary spontaneous pneumothorax? Con: Blebs do not cause primary spontaneous pneumothorax.
J Bronchol, 9 (2002), pp. 319-323
[19]
L Bense, R Lewander, G Eklund, D Odont, G Hedentierna, LG Wiman.
Nonsmoking, non alpha-1-antitrypsin deficiency-induced emphysema in nonsmokers with healed spontaneous pneumothorax, identified by computed tomography of the lungs.
Chest, 103 (1993), pp. 433-438
[20]
JM Tschopp, R Rami-Porta, N Noppen, P Astoul.
Management of spontaneous pneumothorax: state of the art.
Eur Respir J, 28 (2006), pp. 637-650
[21]
KG Jordan, JS Kwong, J Flint, NL Muller.
Surgically treated pneumothorax: radiologic and pathologic findings.
Chest, 111 (1997), pp. 280-285
[22]
O Lesur, N Delorme, JM Frogamet, P Bernadac, JM Polu.
Computed tomography in the etiologic assessment of idiopathic spontaneous pneumothorax.
Chest, 98 (1990), pp. 341-347
[23]
SP Janssen, FM Schramel, TG Sutedja, MA Cuesta, WP Oosterhuir, PE Postmus.
Videothoracoscopic appearance of first and recurrent pneumothorax.
Chest, 108 (1995), pp. 330-334
[24]
DM Donahue, CD Wright, G Viale, DJ Mathisen.
Resection of pulmonary blebs and pleurodesis for spontaneous pneumothorax.
Chest, 104 (1993), pp. 1767-1769
[25]
AD Sihoe, AP Yim, TW Lee, S Wan, EH Yuen, IY Wan, et al.
Can CT scanning be used to select patients with unilateral primary spontaneous pneumothorax for bilateral surgery?.
Chest, 118 (2000), pp. 380-383
[26]
M Ikeda, A Uno, Y Yamane, W Hagiwara.
Median sternotomy with bilateral bullous resection for unilateral spontaneous pneumothorax, with special reference to operative indications.
J Thorac Cardiovasc Surg, 96 (1988), pp. 615-620
[27]
N Horio, H Nomori, R Kobayaski, T Narube, K Suemasu.
Impact of additional pleurodesis in video-assisted thoracoscopic bullectomy for primary spontaneous pneumothorax.
Surg Endosc, 16 (2002), pp. 630-634
[28]
MH Baumann, C Strange, JE Heffner, R Light, TJ Kirby, et al.
Management of spontaneous pneumothorax: an American College of Chest Physicians Delphi Consensus Statement.
Chest, 119 (2001), pp. 590-602
[29]
P De Leyn, M Lismonde, V Niname, M Noopen, H Slabbynck, A Van Meerhaeghe, et al.
Belgian Society of Pneumology: guidelines on the management of spontaneous pneumothorax.
Acta Chir Belg, 105 (2005), pp. 265-267
[30]
FM Schramel, RP Golding, CD Haakman, TG Sutedja, KA De Jong, PE Postmus.
Expiratory chest radiographs do not improve visibility of small apical pneumothoraces by enhanced contrast.
Eur Resp J, 9 (1996), pp. 406-409
[31]
JT Rhea, SA De Luca, RE Greene.
Determining the size of pneumothorax in the upright patient.
Radiology, 144 (1982), pp. 733-736
[32]
MT Henry.
Simple sequential treatment for primary spontaneous pneumothorax: one step closer.
Eur Respir J, 27 (2006), pp. 448-450
[33]
F Uresandi, J Blanquer, F Conget, MA De Gregorio, JL Lobo, R Otero, et al.
Guía para el diagnóstico, tratamiento y seguimiento de la tromboembolia pulmonar.
Arch Bronconeumol, 40 (2004), pp. 580-594
[34]
F García Río, L Borderías, C Casanova, B Celli, J Escarrabill, N González Mangado, et al.
Normativa SEPAR: Patología respiratoria y vuelos en avión.
Arch Bronconeumol, 43 (2007), pp. 1001-1025
[35]
British Thoracic Society Standards of Care Committee.
Managing passengers with respiratory disease planning air travel: British Thoracic Society recommendations.
Thorax, 57 (2002), pp. 289-304
[36]
Aeroscope Medical Association.
Medical Guidelines Task Force, Alexandria. Medical guidelines for airline travel. 2nd ed.
Aviat Space Environ Med, 77 (2003), pp. A1-A19
[37]
British Thoracic Society Fitness to Dive Group Society.
British Thoracic Society guidelines on respiratory aspects of fitness for diving.
Thorax, 58 (2003), pp. 3-13
[38]
CA Jansveld, JH Dijkman.
Primary spontaneous pneumothorax and smoking.
Br Med J, 4 (1975), pp. 559-560
[39]
M Czerny, A Salat, T Fleck, W Hofmann, D Zimpfer, F Eckersberger, et al.
Lung wedge resection improves outcome in stage I primary spontaneous pneumothorax.
Ann Thorac Surg, 77 (2004), pp. 1802-1805
[40]
JP O'Rourke, ES Yee.
Civilian spontaneous pneumothorax: treatment options and long term results.
Chest, 96 (1989), pp. 1302-1306
[41]
LT Kirchen, RL Swartzel.
Spontaneous pneumothorax and its treatment.
JAMA, 155 (1954), pp. 24-29
[42]
C Hernández, K Zugasti, J Emparanza, A Boyero, J Ventura, L Isaba, et al.
Neumotórax espontáneo idiopático: tratamiento basado en la aspiración con catéter fino frente a drenaje torácico.
Arch Bronconeumol, 35 (1999), pp. 179-182
[43]
J Harvey, RJ Prescott.
Simple aspiration versus intercostals tube drainage for spontaneous pneumothorax in patients with normal lungs.
BMJ, 309 (1994), pp. 1338-1339
[44]
AK Ayed, C Chandrasekaran, M Sukumar.
Aspiration versus tube drainage in primary spontaneous pneumothorax: a randomised study.
Eur Respir J, 27 (2006), pp. 477-482
[45]
M Noppen, P Alexander, P Driesen, H Slabbynck, A Verstraeten.
Manual aspiration versus chest tube drainage in first episodes of primary spontaneous pneumothorax: a multicenter, prospective, randomized pilot study.
Am J Respir Crit Care Med, 165 (2002), pp. 1240-1244
[46]
M Baumann, C Strange.
Treatment of spontaneous pneumothorax. A more aggressive approach?.
Chest, 112 (1997), pp. 789-804
[47]
H Minami, H Saka, K Senda, Y Horio, T Iwara, F Nombra, et al.
Small caliber catheter drainage for spontaneous pneumothorax.
Am J Med Sci, 304 (1992), pp. 345-347
[48]
SY So, DY Yu.
Catheter drainage of spontaneous pneumothorax: suction or no suction, early or late removal?.
Thorax, 37 (1982), pp. 46-48
[49]
A Sanni, A Critchley, J Dunning.
Should chest drains be put on suction or not following pulmonary lobectomy?.
Interact Cardiovasc Thorac Surg, 5 (2006), pp. 275-278
[50]
M Noppen.
Pneumothorax and bronchopleural fistula.
Eur Respir Mon, 36 (2006), pp. 165-176
[51]
CBE Chee, J Abisheganaden, JKS Yeo, P Lee, PYM Huan, SC Poh, et al.
Persistent air-leak in spontaneous pneumothorax – clinical course and outcome.
Respir Med, 92 (1998), pp. 757-761
[52]
S Sawada, Y Watanabe, S Moriyama.
Video-assisted thoracoscopic surgery for primary spontaneous pneumothorax. Evaluation of indications and long-term outcome compared with conservative treatment and open thoracotomy.
Chest, 127 (2005), pp. 2226-2230
[53]
E Campos-Werebe, R Pazetti, J Ribas-Milanes-de-Campos, P PêgoFernandez, VL Capelozzi, F Biscegli-Jatene, et al.
Systemic distribution of talc after intrapleural administration in rats.
Chest, 115 (1999), pp. 190-193
[54]
RW Light.
Talc for pleurodesis?.
Chest, 122 (2002), pp. 1506-1508
[55]
M Ando, M Yamamoto, C Kitagawa, A Kumazawa, M Sato, K Shima, et al.
Autologous blood-patch pleurodesis for secondary spontaneous pneumothorax with persistent air leak.
Respir Med, 93 (1999), pp. 432-434
[56]
JJ Rivas de Andrés, S Blanco, M De la Torre.
Postsurgical pleurodesis with autologous blood in patients with persistent air leak.
Ann Thorac Surg, 70 (2000), pp. 270-272
[57]
DA Waller, SA McConnell, PB Rajesh.
Delayed referral reduces the success of video-assisted thoracoscopic surgery for spontaneous pneumothorax.
Respir Med, 92 (1998), pp. 246-249
[58]
P Bagan, F Le Pimpec Barthes, J Assouad, R Souilamas, M Riquet.
Catamenial pneumothorax: retrospective study of surgical treatment.
Ann Thorac Surg, 75 (2003), pp. 378-381
[59]
M Alifano, A Cancellieri, A Fornelli, R Trisolini, M Boaron.
Endometriosis-related pneumothorax: clinico-pathologic observations from a newly diagnosed case.
J Thorac Cardiovasc Surg, 127 (2004), pp. 1219-1221
[60]
S Korom, H Canyurt, A Missbach, D Schneiter, MO Kurrer, U Haller, et al.
Catamenial pneumothorax revisited: clinical approach and systematic review of the literature.
J Thorac Cardiovasc Surg, 128 (2004), pp. 502-508
[61]
P Fonseca.
Catamenial pneumothorax: a multifactorial etiology.
J Thorac Cardiovasc Surg, 116 (1998), pp. 872-873
[62]
PA Kirschner.
Porous diaphragm syndromes.
Chest Surg Clin N Am, 8 (1998), pp. 449-472
[63]
R Harbour, J Millar.
A new system for grading recommendations in evidence based guidelines.
BMJ, 323 (2001), pp. 334-336
Copyright © 2008. Sociedad Española de Neumología y Cirugía Torácica (SEPAR)
Archivos de Bronconeumología
Article options
Tools

Are you a health professional able to prescribe or dispense drugs?