When primary spontaneous pneumothorax presents with minimal symptoms and the patient is clinically and radiologically stable, an evidence-based approach exists that applies regardless of the size of the pneumothorax.
Primary spontaneous pneumothorax that is minimally symptomatic and clinically and radiologically stable — this protocol applies in this specific presentation regardless of the size of the pneumothorax.
The structured protocol for this presentation centres on a conservative management strategy with a defined observation period and an assessment of functional capacity before the patient leaves. The complete criteria, observation requirements, and discharge pathway are available in the full protocol.
Resolution of the pneumothorax confirmed on chest X-ray at 8 weeks.
DOI: 10.1183/13993003.00797-2023
The panel suggests conservative management of PSP in selected cases (minimally symptomatic and clinically and radiologically stable), regardless of size of pneumothorax.
The main body of evidence was obtained from the RCT, which randomised patients (n=316) with large pneumothoraces to either Seldinger chest tube drain (CTD) insertion (n=154) or conservative management with oxygen and analgesia and clinical observation for at least 4 h (n=162).
Patients should be observed for 4 h and must be able to walk comfortably around the emergency department to ensure that they are capable of undertaking routine activities of daily living.
The primary outcome of resolution of the pneumothorax at 8 weeks was achieved by 129 (98.5%) in the CTD group versus 118 (94.4%) in the conservative management group (risk difference −4.1% points, 95% CI −8.6–0.5; p=0.02 for non-inferiority).
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