Oxygen therapy
Immediately administer 100% oxygen. Administration of supplemental oxygen accelerates the rate of pleural air absorption in clinical and experimental situations. By breathing 100% oxygen instead of air, alvelolar pressure of nitrogen falls, and nitrogen is gradually washed out of tissue and oxygen is taken up by vascular system. This causes substantial gradient between tissue capillary and the pneumothorax space, this results in multifold increase in absorption from pleural space. It is recommended that hospitalized patient with any type of pneumothorax who is not subjected to aspiration or tube thoracostomy should be treated with supplemental oxygen at high concentration. Normally 1.25% of the volume of is absorbed in 24 h, hence 10% of the volume is absorbed in 8 days and 20% would be in 16 days and so on.[30]
Majority of the patients with small pneumothoraces often are managed with oxygen administration no treatment other than repeat observation via chest X-rays may be required.
Several prospective studies in both emergency medicine and surgery literature dating back to the mid-1980s have supported the use of needle aspiration and/or small-bore catheter placement for the treatment of pneumothoraces.[31–34]
Complications of tube thoracostomy include death, injury to lung or mediastinum, hemorrhage (usually from intercostal artery injury), neurovascular bundle injury, infection, bronchopleural fistula, and subcutaneous or intraperitoneal tube placement.