Management of Initial Spontaneous Pneumothorax

The survey on management of initial spontaneous pneumothorax provided some interesting results.  Most surgeons manage such patients with a small bore catheter or chest tube, and rarely utilize observation or aspiration.  Despite randomized studies demonstrating the utility of drainage and sclerosis in reducing the risk of recurrent pneumothorax, few surgeons perform sclerosis as part of nonoperative therapy for these patients.  Most surgeons responding to the survey indicated they would wait a week before determining that chest tube drainage had failed.  A surprisingly small number of respondents use talc or other agent to perform sclerosis as part of an operation for pneumothorax. Most surgeons preferred mechanical abrasion or pleurectomy, in spite of experimental studies that demonstrate that a sclerosing agent is more effective than mechanical abrasion for this purpose.

What is your preferred initial therapy for this patient?
		Response Percent	Response Count
a. Observation with oxygen therapy		5.9%	7
b. Aspiration		7.6%	9
c. Thoracic vent or other small bore catheter connected to a valve apparatusd.		22.7%	27
d. Chest tube placement with suction or water seal		63.9%	76
	answered question		119
	skipped question		0

What role does drainage and non-operative chemical pleural sclerosis play in the management of this patient?
		Response Percent	Response Count
a. I never sclerose such patients through a drainage tube		84.9%	101
b. Sclerosis is best used in a patient whose air leak stops within a day or two		2.5%	3
c. Sclerosis is best used in a patient whose air leak is slow to resolve		7.6%	9
d. I use sclerosis routinely in the management of such patients.		5.0%	6
	answered question		119
	skipped question		0

When should surgical intervention be considered for such patients?
		Response Percent	Response Count
a. If the air leak or pneumothorax fails to resolve after two or three days		37.8%	45
b. If the air leak or pneumothorax fails to resolve after a week		53.8%	64
c. Surgical intervention should be a routine part of the initial management of such patients.		8.4%	10
	answered question		119
	skipped question		0

What approach do you use for surgical management of such patients?
		Response Percent	Response Count
a. VATS with small ports only		79.0%	94
b. VATS with an accessory incision		9.2%	11
c. Minithoracotomy (anterior, lateral, or axillary)		10.1%	12
d. Standard thoracotomy		1.7%	2
	answered question		119
	skipped question		0

If a pleural procedure is included as part of your standard operation, what procedure do you use?
		Response Percent	Response Count
a. Mechanical abrasion		47.9%	57
b. Pleurectomy		39.5%	47
c. Talc or other chemical pleurodesis		11.8%	14
d. Pleural tent		0.8%	1
	answered question		119
	skipped question		0

Which specialty initially manages patients with primary spontaneous pneumothorax at your institution?
		Response Percent	Response Count
a. Emergency medicine		22.0%	26
b. Pulmonary medicine		19.5%	23
c. General surgery		5.9%	7
d. Cardiothoracic surgery		52.5%	62
	answered question		118
	skipped question		1

In what region is your surgical practice based?
		Response Percent	Response Count
a. North America		47.9%	57
b. Europe		36.1%	43
c. South America		4.2%	5
d. Asia		9.2%	11
e. Africa		2.5%	3
	answered question		119
	skipped question		0