Resolution of Pneumothorax

1. If pneumothorax is < 15%, administer humidified 100% oxygen through rebreather mask for up to 15-30 minutes to try to reduce the pneumothorax by washing out nitrogen in alveoli and pleural capillaries and enhance diffusion of intrapleural gases into capillaries.

2. If pneumothorax is > 20%, place needle with three-way stopcock and 50-mL syringe in the second anterior intercostal space in the midclavicular line to remove air in the pleural space. If lung reexpansion does not occur, insert a chest tube at the second anterior intercostal space in the midclavicular line or below nipple in the midaxillary line directed toward apical portion of pneumothorax and connected to underwater seal or closed water suction.

3. If pneumothorax does not resolve by 7-10 days despite presence of chest tube and suction, video-assisted thorascopic surgery (VATS) with pleurodesis by mechanical abrasion of parietal pleura, and possibly parietal pleurectomy, is performed.

D. Recurrence of Pneumothorax. Recurrence is likely, particularly if blebs or bullae are present. If a second pneumothorax occurs in the presence of parenchymal blebs and bullae, cystic lesions are removed surgically by VATS, and pleurodesis is performed. Patient should be instructed to seek medical care immediately if chest pain recurs.

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