Joint ERS/EACTS/ESTS clinical practice guidelines on adults with spontaneous pneumothorax

Steven Walker, Robert Hallifax, Sara Ricciardi, Deirdre Fitzgerald, Marlies Keijzers, Olivia Lauk, Jesper Petersen, Luca Bertolaccini, Uffe Bodtger, Amelia Clive, Stefano Elia, Marios Froudarakis, Julius Janssen, Y. C.Gary Lee, Peter Licht, Gilbert Massard, Blin Nagavci, Jens Neudecker, Eric Roessner, Paul Van SchilDavid Waller, Thorsten Walles, Giuseppe Cardillo, Nick Maskell, Najib Rahman

Research output: Contribution to journalReview articlepeer-review

Abstract

OBJECTIVES: The optimal management for spontaneous pneumothorax (SP) remains contentious, with various proposed approaches. This joint clinical practice guideline from the ERS, EACTS and ESTS societies provides evidence-based recommendations for the management of SP. METHODS: This multidisciplinary Task Force addressed 12 key clinical questions on the management of pneumothorax, using ERS methodology for guideline development. Systematic searches were performed in MEDLINE and Embase. Evidence was synthesised by conducting meta-analyses, if possible, or narratively. Certainty of evidence was rated with GRADE (Grading, Recommendation, Assessment, Development and Evaluation). The Evidence to Decision framework was used to decide on the direction and strength of the recommendations. RESULTS: The panel makes a conditional recommendation for conservative care of minimally symptomatic patients with primary spontaneous pneumothorax (PSP) who are clinically stable. We make a strong recommendation for needle aspiration over chest tube drain for initial PSP treatment. We make a conditional recommendation for ambulatory management for initial PSP treatment. We make a conditional recommendation for early surgical intervention for the initial treatment of PSP in patients who prioritise recurrence prevention. The panel makes a conditional recommendation for autologous blood patch in secondary SP patients with persistent air leak (PAL). The panel could not make recommendations for other interventions, including bronchial valves, suction, pleurodesis in addition to surgical resection or type of surgical pleurodesis. CONCLUSIONS: With this international guideline, the ERS, EACTS and ESTS societies provide clinical practice recommendations for SP management. We highlight evidence gaps for the management of PAL and recurrence prevention, with research recommendations made.

Original languageEnglish
Article numberezae189
Number of pages16
JournalEuropean Respiratory Journal
Volume65
Issue number5
DOIs
Publication statusPublished - May 2024

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