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Pneumothorax
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Tratamiento del Neumotórax

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In partial and stable pneumothorax, only observation is made. Thus, patients can only be observed during the first 4-6 h in the Emergency Room. If there is no worsening, they are discharged with a follow-up.

If it worsens, the patient is treated as a complete/total or unstable pneumothorax, and measures are taken to drain the air. A small calibre thoracic drain is attached to a pleural drain with a water seal. This can be done as an outpatient or as an inpatient connected to aspiration for a few hours.

In 70% of cases, the first episode of pneumothorax is resolved with no farther episodes occurring. If pneumothorax reappears, surgical treatment may be needed.

Surgical treatment

The surgical indications for treating pneumothorax are:

  • No resolution of the first pneumothorax episode due to prolonged air leakage (3-5 days) or impossibility of pulmonary re-expansion.
  • Second episode (ipsilateral or contralateral), which occurs in 30% of patients after a first pneumothorax episode. After a second episode, the incidence of a third episode is 60-70%.
  • Synchronous bilateral episode, for its possible severity.
  • Haemothorax associated with pneumothorax, due to bleeding of an intrapleural vessel.
  • Risky professions (pilots and divers).

The surgical technique is videothoracoscopic and is based on finding and resecting target areas or bullae using staplers associated with a pleurodesis technique, either mechanical or chemical abrasion on the parietal pleura or via apical pleurectomy. Relapse rate is low, but can reach 5% in some series.

Surgical complications are minimal, such as bleeding, lack of pulmonary re-expansion and persistent or more frequent air leakage. There are usually no sequelae.

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