Time course of resolution of persistent air leak in spontaneous pneumothorax

Persistent air leak (PAL) following tube drainage for spontaneous pneumothorax (SP) is a potentially troublesome complication. The optimum time to intervene surgically is not known. We therefore investigated the rate of resolution of PAL (defined as continued air leak at 2 days after tube insertion) in patients treated medically. We retrospectively reviewed the records of 214 patients presenting with SP over 5 yr. One hundred and forty-two (67%) had tube drainage and in 73 (51%) of these a PAL developed. Overall median time to resolution in the 43 patients with PAL treated medically was 8 days from tube insertion, but PAL resolution was longer in those with underlying lung disease (n = 19) than those without such disease (11 days vs. 7 days, P = 0.05). In patients with normal lungs 20/24 had resolved by 9 days but subsequently the rate of resolution was much slower. In those with abnormal lungs only 8/19 had resolved by 9 days (P < 0.05 compared with those with normal lungs) but the rate of resolution in such patients appeared to change little subsequently. The size of the initial SP did not influence the rate of resolution of PAL. For patients with PAL and normal lungs, surgery at 7-9 days from tube insertion would provide a reasonable opportunity for the PAL to resolve with medical treatment. For those with underlying lung disease there is no clear optimal time and decisions need to be taken on an individual basis.