R.E.B.E.L.EM - March12, 2020 - By Tarlan Hedayati
"Paper: Brown SGA et al. Conservative Versus Interventional Treatment for Spontaneous Pneumothorax. NEJM 2020. PMID: 31995686
Clinical Question: Is conservative management an acceptable alternative to invasive management for uncomplicated, moderate to large primary spontaneous pneumothorax?
Author Conclusion:“Although the primary outcome was not statistically robust to conservative assumptions about missing data, the trial provides modest evidence that conservative management of primary spontaneous pneumothorax was noninferior to interventional management, with a lower risk of serious adverse events.”
Clinical Take Home Point: In a select and carefully identified subset of patients with large primary spontaneous pneumothorax in a clinical setting that can accommodate both observation and potential emergent intervention, a conservative management approach of observation may obviate the need for chest tubes. For many clinicians, this strategy may not be feasible. The authors of this trial have posed a critical question and laid the foundation for a shift in the management of larger primary spontaneous pneumothoraces."