slide jurnal btkv

8/10/2019 Slide jurnal BTKV

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Co-ass:Wiyasih Widhoretno Eka Puspita

(c11109799)

Supervisor :Dr. dr. Muhammad Nuralim M, Sp.b, Sp.BTKV


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Pneumothorax is a common disease worldwide, butinitial management remains controversial. They differ in

some respects, particularly in initial management.

In this report, we systematically review publishedrandomized controlled trials of the different treatmentsof primary spontaneouspneumothorax, point outcontroversial issues and finally propose a three-stepstrategy for the management of pneumothorax.


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There are 3 importantcharacteristics of pneumothorax :

1. Potentially lethalrespiratory dysfunction

3. Frequent recurrence2. Air leak, which is the

obvious cause of thedisease


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The central idea of the strategy : the lungshould not be expanded rapidly, unless absolutelynecessary.

The primary objective of simple aspiration and chestdrainage should be the recovery of acute respiratorydysfunction or the avoidance of respiratory dysfunction andsubsequent complications.

We believe that this management strategy issimple and clinically relevant and not dependent on theclassification of pneumothorax


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We searched the PubMed database (National Library ofMedicine) used the following search terms pneumothoraxtotal of 331 patient, combine with:

Observation Aspiration or thoracocentesis Chest drain Chest tube or tube drainage

Meta-analysis was performed by combining : Success rate Hospital stay Recurrence rate


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On the basis of our meta-analysis, simple aspiration isrecommended for the initial management of pneumothorax

because of the shorter hospitalization time, although there isno significant difference in the success and recurrence rates.


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Simpson, reported that conservative management of muchlarger pneumothorax is possible if there is no underlying lung

disease. Few retrospective studies compared the success andrecurrence rates of observational and interventional treatment

A review of these reports reveals that the success rate ofobservational treatment is very high and seems to besatisfactory However, the recurrence rate of observationaltreatment tends to be higher than that after intervention.


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Pneumothorax treatment has two goals:

Many other researchers also described thateliminating intrapleural air is the main principle ofpneumothorax treatment.

1. Rid the pleural space ofits air

2. Decrease the likelihood ofa recurrence


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The lung should not be rapidly expanded, unlessnecessary lung should not be rapidly expanded unless

necessary, for example :o Tension pneumothoraxo Continuous air leak even if tension pneumothorax is not

diagnosed during consultation, but is suspected to

subsequently occur

The purpose of tube drainage and simple aspirationshould not be expansion of the lung but recovery of respiratory

dysfunction.


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Pneumothorax is generally considered to be abenign disease with good prognosis, but continuous air

leak can progress into tension pneumothorax with the riskof sudden death. There are several case reports ofdiagnostic difficulty or missed diagnoses of tensionpneumothorax.


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We believe that there are three important characteristics ofpneumothorax:1. Potentially lethal respiratory dysfunction

2. Air leak, which is the obvious cause of the disease3. Frequently occurring recurrence.

These three characteristics correspond to the three steps of ourproposed management in pneumothorax. The central idea is that the lung

should not be expanded rapidly, unless necessary. The primary objective ofboth simple aspiration and chest drainage should be the recovery of acuterespiratory dysfunction or the avoidance of respiratory dysfunction andsubsequent complications. After confirming the air leak, interventions such assimple aspiration or chest drainage and observational treatment may be usedfor the management of the air leak.


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