Cochrane review 2017: simple aspiration vs intercostal tube drainage
Similar immediate success rates
Aspiration associated with less pain and shorter ED stay
ACEP Level B recommendation for aspiration as first-line in PSP
Chest tube advantages
Better for persistent air leak
Required for mechanically ventilated patients
More predictable drainage
Recurrence prevention strategy
Smoking cessation cornerstone of secondary prevention
VATS with pleurodesis gold standard for recurrence prevention
Recurrence rate < 5% post-VATS pleurodesis
Chemical pleurodesis via tube approximately 25% recurrence
Timing of definitive surgery
After first recurrence on same side
Bilateral disease
First episode in high-risk occupations (pilots, divers)
Activity restrictions
Air travel until complete radiographic resolution typically 2 to 6 weeks
Scuba diving generally permanently contraindicated without pleurodesis
Patient Discharge Instructions
copy discharge instructions
What happened
Diagnosed with a simple pneumothorax (collapsed lung)
Air has entered the space around your lung
Your lung is partially or fully collapsed on one side
This can happen without injury especially in young tall individuals who smoke
Treatment at home
Rest and avoid strenuous activity
No heavy lifting or vigorous exercise until cleared
Light walking is acceptable
Supplemental oxygen if prescribed
Use as directed to help lung re-expand
Pain management
Take NSAIDs or acetaminophen as prescribed
Avoid aspirin and ibuprofen if you have stomach problems
Critical restrictions
No air travel until your lung is fully healed
Typically 2 to 6 weeks at minimum
Flying can cause the collapsed lung to expand dangerously at altitude
No scuba diving
Generally permanently contraindicated unless surgery has been performed
Pressure changes can cause reoccurrence
No smoking or vaping
Smoking dramatically increases recurrence risk
Ask your doctor for cessation support
Follow-up appointments
Return for repeat chest X-ray within 12 to 48 hours
To confirm the lung is not getting worse
Then again at 1 week and 4 to 6 weeks
Follow-up with your family doctor or respirologist as arranged
Warning signs to return to ER immediately
Worsening shortness of breath or trouble breathing at rest
Increasing or severe chest pain
Feeling faint, dizzy, or lightheaded
Rapid heart rate you can feel
Blue or grey color of lips or fingernails
New fever or chills
Any symptom that concerns you
References
Guidelines and key sources
Primary clinical guidelines
Joint ERS EACTS ESTS Clinical Practice Guidelines on Adults With Spontaneous Pneumothorax 2024
Walker S, Hallifax R, Ricciardi S, et al.
European Journal of Cardio-Thoracic Surgery 2024
ERS Task Force Statement: Diagnosis and Treatment of Primary Spontaneous Pneumothorax 2015
Tschopp JM, Bintcliffe O, Astoul P, et al.
European Respiratory Journal 2015
ACCP Delphi Consensus Statement on Management of Spontaneous Pneumothorax 2001
Baumann MH, Strange C, Heffner JE, et al.
Chest 2001
Key trials and systematic reviews
Landmark trials
PSP Trial: Conservative versus Interventional Treatment for Spontaneous Pneumothorax
Brown SGA, Ball EL, Perrin K, et al.
New England Journal of Medicine 2020
Conservative management non-inferior with fewer complications and shorter LOS
RAMCAT Trial: Ambulatory Management of Primary Spontaneous Pneumothorax
Hallifax RJ, McKeown E, Sivakumar P, et al.
Lancet 2020
Ambulatory device non-inferior to inpatient management
Cochrane Review: Simple Aspiration versus Intercostal Tube Drainage
Carson-Chahhoud KV, Wakai A, van Agteren JE, et al.
Cochrane Database Systematic Reviews 2017
Recurrence Rates in Primary Spontaneous Pneumothorax: Systematic Review and Meta-Analysis
Walker SP, Bibby AC, Halford P, et al.
European Respiratory Journal 2018
Key references
Supporting literature
Pneumothorax: An Update on Clinical Spectrum, Diagnosis and Management
Iqbal B, Hallifax R, Rahman NM.
Clinical Medicine 2025
PMID 40374117
Spontaneous Pneumothorax
Sahn SA, Heffner JE.
New England Journal of Medicine 2000
Pneumothorax: Classification and Etiology
Huan NC, Sidhu C, Thomas R.
Clinics in Chest Medicine 2021
PMID 34774177
Thoracic Trauma WSES-AAST Guidelines
Coccolini F, Cremonini C, Moore EE, et al.
World Journal of Emergency Surgery 2025
ICD-10 codes
J93.11 Primary spontaneous pneumothorax
J93.12 Secondary spontaneous pneumothorax
J93.0 Tension pneumothorax
S27.0 Traumatic pneumothorax
SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.