PSP

Conservative versus Interventional Treatment for Spontaneous Pneumothorax
Simon G.A. NEJM Jan 30 2020; DOI: 10.1056/NEJMoa1910775]

Clinical Question

• In patients with primary moderate-large spontaneous pneumothorax does conservative management compared to interventional treatment result in acceptable rates of lung re-expansion at 8 weeks
• Acceptable was defined as complete lung re-expansion at 8 weeks in 90% of patients

N = 316, 39 hospitals throughout Australasia

Authors’ Conclusions
-  Modest evidence that conservative management was non inferior to interventional management for radiographic resolution at 8 weeks with the use of a 9% margin
-  Time to resolution of symptoms does not statistically differ between the groups
-  Conservative management spared 85% of patients a chest tube and resulted in fewer hospital days, less surgery and fewer adverse events
-  The results challenge the fundamental principle that all large primary spontaneous pneumothorax require immediate drainage

The Bottom Line

• This paper provides modest evidence that conservative management is an option for moderate to large primary spontaneous pneumothorax
  -  Fewer hospital days, fewer adverse events and a lower re-occurrence rate, all achieved without having a tube inserted into the patient’s thorax, offer compelling reasons to discuss treatment options with the patient and to consider not intervening a reasonable option
  -  The advent and popularity of pleural vents in some centres poses a third option in the management of primary spontaneous pneumothorax that has not been addressed in this paper