Download PDF
Semin Respir Crit Care Med 2010; 31(6): 769-780
DOI: 10.1055/s-0030-1269837
© Thieme Medical Publishers

Management of Pneumothorax

Demondes Haynes1 , Michael H. Baumann1
  • 1Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, University of Mississippi Medical Center, Jackson, Mississippi
Further Information

Publication History

Publication Date:
06 January 2011 (online)

    Permissions and Reprints

ABSTRACT

Pneumothoraces are classified as spontaneous, traumatic, and iatrogenic. Spontaneous pneumothoraces (SPs) occur without recognized lung disease [primary spontaneous pneumothoraces (PSPs)] or due to an underlying lung disease [secondary spontaneous pneumothoraces (SSPs)]. Treatment of PSPs and SSPs has been heterogeneous in the United States. This heterogeneity in management is likely due in part to the fact that the American College of Chest Physicians guidelines and the British Thoracic Society guidelines differ on some management recommendations, including recommendations that pertain to simple aspiration. Traumatic pneumothoraces due to penetrating or nonpenetrating (blunt) trauma usually require the placement of a larger-bore chest tube. Iatrogenic pneumothoraces, most commonly due to transthoracic needle aspiration, may be treated in carefully selected patients with observation. The presence of underlying emphysema in the setting of an iatrogenic pneumothorax usually mandates placement of a drainage catheter.

KEYWORDS

Pneumothorax - spontaneous - traumatic - iatrogenic - management

REFERENCES

  • 1 Light R W, Lee G YC. Pneumothorax, chylothorax, hemothorax, and fibrothorax. In: Mason R J, Broaddus C V, Martin T, et al, eds. Textbook of Respiratory Medicine. 5th ed. Philadelphia: WB Saunders; 2010: 1961-1988
    Google Scholar
  • 2 Rahman N M, Davies RJO, Gleeson F V. Pleural interventions: management of acute and chronic pneumothorax.  Semin Respir Crit Care Med. 2008;  29 427-440
    Article in Thieme ConnectPubMedGoogle Scholar
  • 3 Bense L, Lewander R, Eklund G, Hedenstierna G, Wiman L G. Nonsmoking, non-alpha 1-antitrypsin deficiency-induced emphysema in nonsmokers with healed spontaneous pneumothorax, identified by computed tomography of the lungs.  Chest. 1993;  103 433-438
    CrossrefPubMedGoogle Scholar
  • 4 Bense L, Eklund G, Wiman L-G. Smoking and the increased risk of contracting spontaneous pneumothorax.  Chest. 1987;  92 1009-1012
    CrossrefPubMedGoogle Scholar
  • 5 Cottin V, Streichenberger N, Gamondès J-P, Thévenet F, Loire R, Cordier J-F. Respiratory bronchiolitis in smokers with spontaneous pneumothorax.  Eur Respir J. 1998;  12 702-704
    CrossrefPubMedGoogle Scholar
  • 6 MacDuff A, Arnold A, Harvey J. BTS Pleural Disease Guideline Group . Management of spontaneous pneumothorax: British Thoracic Society pleural disease guideline 2010.  Thorax. 2010;  65(Suppl 2) ii18-ii31
    CrossrefPubMedGoogle Scholar
  • 7 Melton III L J, Hepper NGG, Offord K P. Incidence of spontaneous pneumothorax in Olmsted County, Minnesota: 1950 to 1974.  Am Rev Respir Dis. 1979;  120 1379-1382
    PubMedGoogle Scholar
  • 8 Baumann M H, Strange C. Treatment of spontaneous pneumothorax: a more aggressive approach?.  Chest. 1997;  112 789-804
    CrossrefPubMedGoogle Scholar
  • 9 Baumann M H, Strange C, Heffner J E AACP Pneumothorax Consensus Group et al. Management of spontaneous pneumothorax: an American College of Chest Physicians Delphi consensus statement.  Chest. 2001;  119 590-602
    CrossrefPubMedGoogle Scholar
  • 10 Henry M, Arnold T, Harvey J. Pleural Diseases Group, Standards of Care Committee, British Thoracic Society . BTS guidelines for the management of spontaneous pneumothorax.  Thorax. 2003;  58(Suppl 2) ii39-ii52
    CrossrefPubMedGoogle Scholar
  • 11 Donahue D M, Wright C D, Viale G, Mathisen D J. Resection of pulmonary blebs and pleurodesis for spontaneous pneumothorax.  Chest. 1993;  104 1767-1769
    CrossrefPubMedGoogle Scholar
  • 12 Ohata M, Suzuki H. Pathogenesis of spontaneous pneumothorax: with special reference to the ultrastructure of emphysematous bullae.  Chest. 1980;  77 771-776
    CrossrefPubMedGoogle Scholar
  • 13 Noppen M, Dekeukeleire T, Hanon S et al.. Fluorescein-enhanced autofluorescence thoracoscopy in patients with primary spontaneous pneumothorax and normal subjects.  Am J Respir Crit Care Med. 2006;  174 26-30
    CrossrefPubMedGoogle Scholar
  • 14 Withers J N, Fishback M E, Kiehl P V, Hannon J L. Spontaneous pneumothorax.  Am J Surg. 1964;  108 772-776
    CrossrefPubMedGoogle Scholar
  • 15 Baumann M H. Treatment of spontaneous pneumothorax.  Curr Opin Pulm Med. 2000;  6 275-280
    CrossrefPubMedGoogle Scholar
  • 16 Chiu H T, Garcia C K. Familial spontaneous pneumothorax.  Curr Opin Pulm Med. 2006;  12 268-272
    CrossrefPubMedGoogle Scholar
  • 17 Cardy C M, Maskell N A, Handford P A et al.. Familial spontaneous pneumothorax and FBN1 mutations.  Am J Respir Crit Care Med. 2004;  169 1260-1262
    PubMedGoogle Scholar
  • 18 Alifano M, Forti Parri S N, Bonfanti B et al.. Atmospheric pressure influences the risk of pneumothorax: beware of the storm!.  Chest. 2007;  131 1877-1882
    CrossrefPubMedGoogle Scholar
  • 19 Noppen M, Verbanck S, Harvey J et al.. Music: a new cause of primary spontaneous pneumothorax.  Thorax. 2004;  59 722-724
    CrossrefPubMedGoogle Scholar
  • 20 Sahn S A, Heffner J E. Spontaneous pneumothorax.  N Engl J Med. 2000;  342 868-874
    CrossrefPubMedGoogle Scholar
  • 21 Light R W. Management of spontaneous pneumothorax.  Am Rev Respir Dis. 1993;  148 245-248
    CrossrefPubMedGoogle Scholar
  • 22 Wait M A, Estrera A. Changing clinical spectrum of spontaneous pneumothorax.  Am J Surg. 1992;  164 528-531
    CrossrefPubMedGoogle Scholar
  • 23 Gupta D, Hansell A, Nichols T, Duong T, Ayres J G, Strachan D. Epidemiology of pneumothorax in England.  Thorax. 2000;  55 666-671
    CrossrefPubMedGoogle Scholar
  • 24 Videm V, Pillgram-Larsen J, Ellingsen O, Andersen G, Ovrum E. Spontaneous pneumothorax in chronic obstructive pulmonary disease: complications, treatment and recurrences.  Eur J Respir Dis. 1987;  71 365-371
    PubMedGoogle Scholar
  • 25 Maeda A, Ishioka S, Yoshihara M, Mihara M, Shigenobu T, Nakamura S. Primary spontaneous pneumothorax detected during a medical checkup.  Chest. 1999;  116 847-848
    CrossrefPubMedGoogle Scholar
  • 26 Kadokura M, Nonaka M, Yamamoto S et al.. Five cases of asymptomatic spontaneous pneumothorax.  Ann Thorac Cardiovasc Surg. 1999;  5 187-190
    PubMedGoogle Scholar
  • 27 Schramel FMNH, Golding R P, Haakman CDE, Sutedja T G, de Jong K A, Postmus P E. Expiratory chest radiographs do not improve visibility of small apical pneumothoraces by enhanced contrast.  Eur Respir J. 1996;  9 406-409
    CrossrefPubMedGoogle Scholar
  • 28 Bradley M, Williams C, Walshaw M J. The value of routine expiratory chest films in the diagnosis of pneumothorax.  Arch Emerg Med. 1991;  8 115-116
    PubMedGoogle Scholar
  • 29 Engdahl O, Toft T, Boe J. Chest radiograph—a poor method for determining the size of a pneumothorax.  Chest. 1993;  103 26-29
    CrossrefPubMedGoogle Scholar
  • 30 Trupka A, Waydhas C, Hallfeldt K K, Nast-Kolb D, Pfeifer K J, Schweiberer L. Value of thoracic computed tomography in the first assessment of severely injured patients with blunt chest trauma: results of a prospective study.  J Trauma. 1997;  43 405-411, discussion 411–412
    CrossrefPubMedGoogle Scholar
  • 31 Lichtenstein D A. Ultrasound examination of the lungs in the intensive care unit.  Pediatr Crit Care Med. 2009;  10 693-698
    CrossrefPubMedGoogle Scholar
  • 32 Ball C G, Kirkpatrick A W, Feliciano D V. The occult pneumothorax: what have we learned?.  Can J Surg. 2009;  52 E173-E179
    PubMedGoogle Scholar
  • 33 Slater A, Goodwin M, Anderson K E, Gleeson F V. COPD can mimic the appearance of pneumothorax on thoracic ultrasound.  Chest. 2006;  129 545-550
    CrossrefPubMedGoogle Scholar
  • 34 Schramel F M, Postmus P E, Vanderschueren R G. Current aspects of spontaneous pneumothorax.  Eur Respir J. 1997;  10 1372-1379
    CrossrefPubMedGoogle Scholar
  • 35 Light R W, O'Hara V S, Moritz T E et al.. Intrapleural tetracycline for the prevention of recurrent spontaneous pneumothorax. Results of a Department of Veterans Affairs cooperative study.  JAMA. 1990;  264 2224-2230
    CrossrefPubMedGoogle Scholar
  • 36 Lippert H L, Lund O, Blegvad S, Larsen H V. Independent risk factors for cumulative recurrence rate after first spontaneous pneumothorax.  Eur Respir J. 1991;  4 324-331
    PubMedGoogle Scholar
  • 37 Baumann M H, Strange C. The clinician's perspective on pneumothorax management.  Chest. 1997;  112 822-828
    CrossrefPubMedGoogle Scholar
  • 38 Kircher Jr L T, Swartzel R L. Spontaneous pneumothorax and its treatment.  J Am Med Assoc. 1954;  155 24-29
    CrossrefPubMedGoogle Scholar
  • 39 Chadha T S, Cohn M A. Noninvasive treatment of pneumothorax with oxygen inhalation.  Respiration. 1983;  44 147-152
    CrossrefPubMedGoogle Scholar
  • 40 Northfield T C. Oxygen therapy for spontaneous pneumothorax.  BMJ. 1971;  4 86-88
    CrossrefPubMedGoogle Scholar
  • 41 Kelly A-M, Loy J, Tsang AYL, Graham C A. Estimating the rate of re-expansion of spontaneous pneumothorax by a formula derived from computed tomography volumetry studies.  Emerg Med J. 2006;  23 780-782
    CrossrefPubMedGoogle Scholar
  • 42 Moran J F, Jones R H, Wolfe W G. Regional pulmonary function during experimental unilateral pneumothorax in the awake state.  J Thorac Cardiovasc Surg. 1977;  74 396-402
    PubMedGoogle Scholar
  • 43 O'Rourke J P, Yee E S. Civilian spontaneous pneumothorax: treatment options and long-term results.  Chest. 1989;  96 1302-1306
    CrossrefPubMedGoogle Scholar
  • 44 Kelly A-M, Kerr D, Clooney M. Outcomes of emergency department patients treated for primary spontaneous pneumothorax.  Chest. 2008;  134 1033-1036
    CrossrefPubMedGoogle Scholar
  • 45 Soulsby T. British Thoracic Society guidelines for the management of spontaneous pneumothorax: do we comply with them and do they work?.  J Accid Emerg Med. 1998;  15 317-321
    PubMedGoogle Scholar
  • 46 Noppen M, Alexander P, Driesen P, Slabbynck H, Verstraeten A. Manual aspiration versus chest tube drainage in first episodes of primary spontaneous pneumothorax.  Am J Respir Crit Care Med. 2002;  165 1240-1244
    CrossrefPubMedGoogle Scholar
  • 47 Wakai A, O'Sullivan R G, McCabe G. Simple aspiration versus intercostal tube drainage for primary spontaneous pneumothorax in adults.  Cochrane Database Syst Rev. 2007;  (1) CD004479
    PubMedGoogle Scholar
  • 48 Ayed A K, Chandrasekaran C, Sukumar M. Aspiration versus tube drainage in primary spontaneous pneumothorax: a randomised study.  Eur Respir J. 2006;  27 477-482
    CrossrefPubMedGoogle Scholar
  • 49 Henry M T. Simple sequential treatment for primary spontaneous pneumothorax: one step closer.  Eur Respir J. 2006;  27 448-450
    CrossrefPubMedGoogle Scholar
  • 50 Baumann M H, Sahn S A. Medical management and therapy of bronchopleural fistulas in the mechanically ventilated patient.  Chest. 1990;  97 721-728
    CrossrefPubMedGoogle Scholar
  • 51 Haynes D, Baumann M H. Chest tubes. In: Bouros D, ed. Pleural Disease. New York: Informa Healthcare; 2010: 92-107
    Google Scholar
  • 52 Baumann M H, Patel P B, Roney C W, Petrini M F. Comparison of function of commercially available pleural drainage units and catheters.  Chest. 2003;  123 1878-1886
    CrossrefPubMedGoogle Scholar
  • 53 So S Y, Yu D Y. Catheter drainage of spontaneous pneumothorax: suction or no suction, early or late removal?.  Thorax. 1982;  37 46-48
    CrossrefPubMedGoogle Scholar
  • 54 Minami H, Saka H, Senda K et al.. Small caliber catheter drainage for spontaneous pneumothorax.  Am J Med Sci. 1992;  304 345-347
    CrossrefPubMedGoogle Scholar
  • 55 Miller AC. Treatment of spontaneous pneumothorax: the clinician's perspective on pneumothorax management.  Chest. 1998;  113 1423-1424
    PubMedGoogle Scholar
  • 56 Baumann M H, Strange C. The clinician's perspective on pneumothorax management.  Chest. 1997;  112 822-828
    CrossrefPubMedGoogle Scholar
  • 57 Schoenenberger R A, Haefeli W E, Weiss P, Ritz R F. Timing of invasive procedures in therapy for primary and secondary spontaneous pneumothorax.  Arch Surg. 1991;  126 764-766
    CrossrefPubMedGoogle Scholar
  • 58 Light R W. Pleural Disease. 3rd ed. Baltimore: Williams and Wilkins; 1995
    Google Scholar
  • 59 Chee CBE, Abisheganaden J, Yeo JKS et al.. Persistent air-leak in spontaneous pneumothorax—clinical course and outcome.  Respir Med. 1998;  92 757-761
    CrossrefPubMedGoogle Scholar
  • 60 Mathur R, Cullen J, Kinnear WJM, Johnston IDA. Time course of resolution of persistent air leak in spontaneous pneumothorax.  Respir Med. 1995;  89 129-132
    CrossrefPubMedGoogle Scholar
  • 61 Jain S K, Al-Kattan K M, Hamdy M G. Spontaneous pneumothorax: determinants of surgical intervention.  J Cardiovasc Surg (Torino). 1998;  39 107-111
    PubMedGoogle Scholar
  • 62 Vohra H A, Adamson L, Weeden D F. Does video-assisted thoracoscopic pleurectomy result in better outcomes than open pleurectomy for primary spontaneous pneumothorax?.  Interact Cardiovasc Thorac Surg. 2008;  7 673-677
    CrossrefPubMedGoogle Scholar
  • 63 Matsuzoe D, Iwasaki A, Okabayashi K et al.. Recurrence after thoracoscopic surgery for spontaneous pneumothorax.  Int Surg. 1999;  84 111-114
    PubMedGoogle Scholar
  • 64 Waller D A, McConnell S A, Rajesh P B. Delayed referral reduces the success of video-assisted thoracoscopic surgery for spontaneous pneumothorax.  Respir Med. 1998;  92 246-249
    CrossrefPubMedGoogle Scholar
  • 65 Travaline J M, McKenna Jr R J, De Giacomo T Endobronchial Valve for Persistent Air Leak Group et al. Treatment of persistent pulmonary air leaks using endobronchial valves.  Chest. 2009;  136 355-360
    CrossrefPubMedGoogle Scholar
  • 66 Rinaldi S, Felton T, Bentley A. Blood pleurodesis for the medical management of pneumothorax.  Thorax. 2009;  64 258-260
    CrossrefPubMedGoogle Scholar
  • 67 Heffner J E, Standerfer R J, Torstveit J, Unruh L. Clinical efficacy of doxycycline for pleurodesis.  Chest. 1994;  105 1743-1747
    CrossrefPubMedGoogle Scholar
  • 68 Kennedy L, Sahn S A. Talc pleurodesis for the treatment of pneumothorax and pleural effusion.  Chest. 1994;  106 1215-1222
    CrossrefPubMedGoogle Scholar
  • 69 Kennedy L, Vaughan L M, Steed L L, Sahn S A. Sterilization of talc for pleurodesis. Available techniques, efficacy, and cost analysis.  Chest. 1995;  107 1032-1034
    CrossrefPubMedGoogle Scholar
  • 70 Chappell A, Johnson A, Charles J Research Committee of the British Thoracic Association and the Medical Research Council Pneumoconiosis Unit et al. A survey of the long-term effects of talc and kaolin pleurodesis.  Br J Dis Chest. 1979;  73 285-288
    CrossrefPubMedGoogle Scholar
  • 71 Sahn S A. Talc should be used for pleurodesis.  Am J Respir Crit Care Med. 2000;  162 2023-2024, discussion 2026
    PubMedGoogle Scholar
  • 72 Light R W. Talc should not be used for pleurodesis.  Am J Respir Crit Care Med. 2000;  162 2024-2026
    PubMedGoogle Scholar
  • 73 Maskell N A, Lee Y C, Gleeson F V, Hedley E L, Pengelly G, Davies RJO. Randomized trials describing lung inflammation after pleurodesis with talc of varying particle size.  Am J Respir Crit Care Med. 2004;  170 377-382
    CrossrefPubMedGoogle Scholar
  • 74 Ferrer J, Villarino M A, Tura J M, Traveria A, Light R W. Talc preparations used for pleurodesis vary markedly from one preparation to another.  Chest. 2001;  119 1901-1905
    CrossrefPubMedGoogle Scholar
  • 75 de Campos JRM, Vargas F S, de Campos Werebe E et al.. Thoracoscopy talc poudrage: a 15-year experience.  Chest. 2001;  119 801-806
    CrossrefPubMedGoogle Scholar
  • 76 Enderson B L, Abdalla R, Frame S B, Casey M T, Gould H, Maull K I. Tube thoracostomy for occult pneumothorax: a prospective randomized study of its use.  J Trauma. 1993;  35 726-729, discussion 729–730
    CrossrefPubMedGoogle Scholar
  • 77 Bridges K G, Welch G, Silver M, Schinco M A, Esposito B. CT detection of occult pneumothorax in multiple trauma patients.  J Emerg Med. 1993;  11 179-186
    CrossrefPubMedGoogle Scholar
  • 78 Wolfman N T, Myers W S, Glauser S J, Meredith J W, Chen MYM. Validity of CT classification on management of occult pneumothorax: a prospective study.  AJR Am J Roentgenol. 1998;  171 1317-1320
    PubMedGoogle Scholar
  • 79 Trupka A, Waydhas C, Hallfeldt K K, Nast-Kolb D, Pfeifer K J, Schweiberer L. Value of thoracic computed tomography in the first assessment of severely injured patients with blunt chest trauma: results of a prospective study.  J Trauma. 1997;  43 405-411, discussion 411–412
    CrossrefPubMedGoogle Scholar
  • 80 Blaivas M, Lyon M, Duggal S. A prospective comparison of supine chest radiography and bedside ultrasound for the diagnosis of traumatic pneumothorax.  Acad Emerg Med. 2005;  12 844-849
    CrossrefPubMedGoogle Scholar
  • 81 Soldati G, Testa A, Sher S, Pignataro G, La Sala M, Silveri N G. Occult traumatic pneumothorax: diagnostic accuracy of lung ultrasonography in the emergency department.  Chest. 2008;  133 204-211
    CrossrefPubMedGoogle Scholar
  • 82 Weissberg D, Refaely Y. Pneumothorax: experience with 1,199 patients.  Chest. 2000;  117 1279-1285
    CrossrefPubMedGoogle Scholar
  • 83 Despars J A, Sassoon CSH, Light R W. Significance of iatrogenic pneumothoraces.  Chest. 1994;  105 1147-1150
    CrossrefPubMedGoogle Scholar
  • 84 Sznajder J I, Zveibil F R, Bitterman H, Weiner P, Bursztein S. Central vein catheterization. Failure and complication rates by three percutaneous approaches.  Arch Intern Med. 1986;  146 259-261
    CrossrefPubMedGoogle Scholar
  • 85 Sassoon CSH, Light R W, O'Hara V S, Moritz T E. Iatrogenic pneumothorax: etiology and morbidity. Results of a Department of Veterans Affairs Cooperative Study.  Respiration. 1992;  59 215-220
    CrossrefPubMedGoogle Scholar
  • 86 Berger R. Iatrogenous pneumothorax.  Chest. 1994;  105 980-982
    CrossrefPubMedGoogle Scholar
  • 87 de Lassence A, Timsit J-F, Tafflet M OUTCOMEREA Study Group et al. Pneumothorax in the intensive care unit: incidence, risk factors, and outcome.  Anesthesiology. 2006;  104 5-13
    CrossrefPubMedGoogle Scholar
  • 88 Choi C-M, Um S-W, Yoo C-G et al.. Incidence and risk factors of delayed pneumothorax after transthoracic needle biopsy of the lung.  Chest. 2004;  126 1516-1521
    CrossrefPubMedGoogle Scholar
  • 89 Yeow K-M, Su I-H, Pan K-T et al.. Risk factors of pneumothorax and bleeding: multivariate analysis of 660 CT-guided coaxial cutting needle lung biopsies.  Chest. 2004;  126 748-754
    CrossrefPubMedGoogle Scholar
  • 90 Topal U, Ediz B. Transthoracic needle biopsy: factors effecting risk of pneumothorax.  Eur J Radiol. 2003;  48 263-267
    CrossrefPubMedGoogle Scholar
  • 91 Yamagami T, Nakamura T, Iida S, Kato T, Nishimura T. Management of pneumothorax after percutaneous CT-guided lung biopsy.  Chest. 2002;  121 1159-1164
    CrossrefPubMedGoogle Scholar
  • 92 Saji H, Nakamura H, Tsuchida T et al.. The incidence and the risk of pneumothorax and chest tube placement after percutaneous CT-guided lung biopsy: the angle of the needle trajectory is a novel predictor.  Chest. 2002;  121 1521-1526
    CrossrefPubMedGoogle Scholar
  • 93 Laurent F, Michel P, Latrabe V, Tunon de Lara M, Marthan R. Pneumothoraces and chest tube placement after CT-guided transthoracic lung biopsy using a coaxial technique: incidence and risk factors.  AJR Am J Roentgenol. 1999;  172 1049-1053
    CrossrefPubMedGoogle Scholar
  • 94 Cox J E, Chiles C, McManus C M, Aquino S L, Choplin R H. Transthoracic needle aspiration biopsy: variables that affect risk of pneumothorax.  Radiology. 1999;  212 165-168
    CrossrefPubMedGoogle Scholar
  • 95 Baumann M H. Non-spontaneous pneumothorax. In: Light RW, Lee G YC, eds. Textbook of Pleural Disease. 2nd ed. London: Hodder Arnold; 2008: 533-544
    Google Scholar
  • 96 Anderson CLV, Crespo J C, Lie T H. Risk of pneumothorax not increased by obstructive lung disease in percutaneous needle biopsy.  Chest. 1994;  105 1705-1708
    CrossrefPubMedGoogle Scholar
  • 97 Fish G D, Stanley J H, Miller K S, Schabel S I, Sutherland S E. Postbiopsy pneumothorax: estimating the risk by chest radiography and pulmonary function tests.  AJR Am J Roentgenol. 1988;  150 71-74
    CrossrefPubMedGoogle Scholar
  • 98 Miller K S, Fish G B, Stanley J H, Schabel S I. Prediction of pneumothorax rate in percutaneous needle aspiration of the lung.  Chest. 1988;  93 742-745
    CrossrefPubMedGoogle Scholar
  • 99 Steier M, Ching N, Bonfils-Roberts E, Nealon Jr T F. Iatrogenic causes of pneumothorax: increasing incidence with advances in medical care.  N Y State J Med. 1973;  73 1296-1298
    PubMedGoogle Scholar
  • 100 Amato M B, Barbas C S, Medeiros D M et al.. Effect of a protective-ventilation strategy on mortality in the acute respiratory distress syndrome.  N Engl J Med. 1998;  338 347-354
    CrossrefPubMedGoogle Scholar
  • 101 Network ARDS. The Acute Respiratory Distress Syndrome Network . Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome.  N Engl J Med. 2000;  342 1301-1308
    CrossrefPubMedGoogle Scholar
  • 102 Gordon C E, Feller-Kopman D, Balk E M, Smetana G W. Pneumothorax following thoracentesis: a systematic review and meta-analysis.  Arch Intern Med. 2010;  170 332-339
    CrossrefPubMedGoogle Scholar
  • 103 Havelock T, Teoh R, Laws D, Gleeson F, Maskell N A. BTS Pleural Disease Guideline Group . Pleural procedures and thoracic ultrasound: British Thoracic Society pleural disease guideline 2010.  Thorax. 2010;  65(Suppl 2) ii61-ii76
    PubMedGoogle Scholar
  • 104 Laronga C, Meric F, Truong M T, Mayfield C, Mansfield P. A treatment algorithm for pneumothoraces complicating central venous catheter insertion.  Am J Surg. 2000;  180 523-526, discussion 526–527
    CrossrefPubMedGoogle Scholar
  • 105 Brown K T, Brody L A, Getrajdman G I, Napp T E. Outpatient treatment of iatrogenic pneumothorax after needle biopsy.  Radiology. 1997;  205 249-252
    CrossrefPubMedGoogle Scholar
  • 106 Delius R E, Obeid F N, Horst H M, Sorensen V J, Fath J J, Bivins B A. Catheter aspiration for simple pneumothorax: experience with 114 patients.  Arch Surg. 1989;  124 833-836
    CrossrefPubMedGoogle Scholar
  • 107 Schoenenberger R A, Haefeli W E, Weiss P, Ritz R. Evaluation of conventional chest tube therapy for iatrogenic pneumothorax.  Chest. 1993;  104 1770-1772
    CrossrefPubMedGoogle Scholar

Demondes HaynesM.D. 

Division of Pulmonary, Critical Care, and Sleep Medicine, University of Mississippi Medical Center

2500 North State St., Jackson, MS 39216

Email: dhaynes@umc.edu