[Variations of primary spontaneous pneumothorax management]

The aim of our study was to determine the current practice and variation among pulmonologists, general and thoracic surgeons treating primary spontaneous pneumothorax (PSP) in the Czech Republic.

A pneumothorax questionnaire was mailed to 153 chiefs of departments of general surgery, pneumology and to thoracic surgeons (55 pulmonologists, 75 general surgeons, 23 thoracic surgeons). Mail contained the survey questionnaire and cover letter requesting the recipients' participation and explaining the purpose of the research. National survey questionnaire included questions on PSP management, chest tube attachment preferences and its removal management

Ninety seven respondents (63%) answered the survey. This included 28 pulmonologists (28/55, 52%), 48 general surgeons (49/75, 64%) and 20 thoracic surgeons (20/23, 87%). Sixty nine percent of respondents treat first PSP with chest tube, 6% by aspiration. Seventy four percent of respondents insert chest tube in the second intercostal space midclavicular line and 22% in the fourth intercostal space midaxillary line. Nearly 71% of pulmonologists use < 18F chest tube, 85% of thoracic surgeons insert a 20-24F chest tube. Active suction use 56% of respondents. Seventy four percent of physicians clamp chest tube prior its removal. Thirty nine percent of respondents pull out a chest tube at the end of inspirium, and 33% at the end of expirium.

Marked practice variations exist among physicians treating spontaneous pneumothorax. Variations exist not only between pulmonologists and surgeons, but also in the group of surgeons itself.