How do you treat spontaneous pneumothorax?
Treatment of spontaneous pneumothorax depends on its size and whether underlying lung disease is present. An approach to management stratifies small (less than 2 cm) and large (2 cm or more) pneumothoraces between the lung and chest wall. A 2-cm pneumothorax approximates half the volume of the hemithorax. Simple aspiration is less likely to succeed in secondary spontaneous pneumothorax and is only recommended as an initial treatment of pneumothoraces less than 2 cm in minimally breathless patients younger than 50 years. Patients with primary spontaneous pneumothoraces that resolve with aspiration may be discharged, but hospitalization is recommended for patients with secondary spontaneous pneumothoraces. Small chest tubes are as effective as large ones, and small tubes should initially be used. Suction is not initially indicated because of the risk of re-expansion pulmonary edema and can be added after 48 hours if the pneumothorax persists. Initial tube thoracostomy, preferably with a small-bore catheter, is appropriate for secondary pneumothoraces more than 2 cm, particularly in patients older than 50 years.