A place for aspiration in the treatment of spontaneous pneumothorax

In a retrospective survey of 195 patients with spontaneous pneumothorax, 100 had a deep (greater than 20%) air space. Thirty one patients were considered unsuitable for aspiration because of complicating disease. Sixty nine patients were treated by aspiration, and in 45 of these reexpansion was sufficient for the case to be managed as shallow pneumothorax while the patient remained ambulant. The average initial aspiration from the 69 patients was 1 X 1 litres. The intrapleural pressure was subatmospheric in only 22 (49%) of the 45 successfully aspirated patients. A chest radiograph several hours after aspiration is the principal control required for this treatment. The recurrence rate was 11.1%. Of 95 patients with a shallow pneumothorax, 3 were intubated for progressive lung collapse and the remainder were encouraged to lead a normal life. The recurrence rate was 11.6%. Retrospectively, it was concluded that 137 patients (70%) had a closed pneumothorax at diagnosis. Primary intubation of all patients with a deep pneumothorax would have represented overtreatment.