Pneumothorax

S5A – Pleural Disease
PNEUMOTHORAX – READY TO GO TUBELESS

Huan Nai Chien
Queen Elizabeth Hospital, Kota Kinabalu, Sabah, Malaysia

The traditional approach to managing patients with primary spontaneous pneumothorax (PSP) has shifted in recent years. Previously, chest tube drainage was commonly used for all cases, but now there is a preference for conservative or outpatient ambulatory management strategies. The change is based on symptom-based care rather than relying solely on imaging. Landmark trials have shown that PSP patients treated conservatively spent significantly fewer days off work/school or at hospitals and were less likely to require surgery or develop recurrence. Ambulatory devices for PSP reduce the length of hospital stay over the first month compared to chest tube drainage. Conservative management can therefore be offered to symptomatic patients with PSP who remain clinically stable after a period of observation and can be readily reassessed in healthcare facilities. For patients deemed unsuitable for conservative care, needle aspiration or chest tube drainage are viable options. In contrast, conservative management cannot be routinely recommended for patients with secondary spontaneous pneumothorax (SSP) due to a lack of evidence. Patients with SSP are more likely to require chest tube drainage due to underlying diseased lungs with poor lung reserves. In summary, the care of patients with pneumothorax (particularly PSP), is increasingly favouring less invasive approaches. This shift focuses on improving patient-reported outcomes by reducing interventions, minimising hospital stays, and enhancing quality of life. “Less is more.”