Spontaneous Pneumothorax: Simple Aspiration or Chest Tube?

In the U.S., patients with spontaneous pneumothorax usually receive chest tubes; in other countries, simple aspiration often is used for a first pneumothorax. The latter is less painful and can help avoid hospitalization but also can be associated with recurrence or incomplete resolution.

French investigators randomized almost 400 young adults (age, ≤50; mean age, 28) with first simple pneumothorax from 31 emergency departments to either simple aspiration or chest tube placement (16- or 20-French). Patients with underlying lung disease were excluded. Initial analgesia was standardized. Patients who underwent successful aspiration were observed for 24 hours. If a chest tube was placed, it was maintained for at least 3 days.

Failure to achieve …