spontaneous pneumothorax: needle aspiration or tube thoracostomy?

11 Mar

it depends… (awesome answer, no?)

A 2008 Annals Review on primary spontaneous pneumothorax:

Three randomized trials with acceptable quality standards met the inclusion criteria.

no significant difference between needle aspiration and tube thoracostomy when outcomes of

  • immediate failure,
  • 1-week failure,
  • risk of complication,
  • 1-year recurrence rate


needle aspiration was associated with

  • lower rates of hospitalization: relative risks of 0.26 (95% confidence interval [CI] 0.17 to 0.39) and 0.51 (95% CI 0.36 to 0.74).
  • shorter length of hospital stay (~0-3 days)
  • less analgesia requirement in one trial and lower pain scores in another.


on the other hand… (via Up to date):

Secondary spontaneous pneumothorax

  • well-described complication of giant bullae (e.g. COPD); also consider interstitial lung dz, neoplasm, collagen vascular dz
  • should be hospitalized because the diminished pulmonary reserve due to underlying lung disease increases the risk of an adverse outcome (eg, persistent air leak, hypoxemia, respiratory failure).
  • Subsequent management is directed at preventing recurrence (e.g. pleurodesis via VATS, bullectomy).
  • Tube thoracostomy is generally preferred over needle aspiration 
    • In one trial, 28 patients got tube thoracostomy, 33 patients got needle aspiration.
    • tube thoracostomy group was more likely to have their pleural air completely evacuated than the needle aspiration group (93 versus 67 percent).
    • The lower success rate of pleural aspiration in SSP than primary spontaneous pneumothorax may be due to a higher rate of persistent air leakage


Submitted by Heather Reed-Day.


References: pubmed article; uptodate.com; picture


One Response to “spontaneous pneumothorax: needle aspiration or tube thoracostomy?”


  1. Treatment of Primary Spontaneous Pneumothoraces | DAILYEM - August 12, 2014

    […] -There is pretty good data (multiple recent articles) behind needle aspiration of pneumothoraces instead of placing a chest tube. This is the recommended treatment in England but this is not in the American College of Chest Physicians guidelines.  A 2008 Annals review shows no difference in rate of failure/recurrence but lower rates of hospitalization, length of stay, comfort.  HRD has a prior blog post about this. […]

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