Main results
We identified 358 studies with duplicates removed. There were three potentially relevant studies that we excluded as they were not
randomized controlled trials. There was one ongoing trial that was relevant and we contacted the authors and confirmed the study is
ongoing at June 2014. We will update this review when this ongoing study is completed.
Authors’ conclusions
There are no completed randomized controlled trials comparing conservative and interventional management for primary spontaneous
pneumothorax in adults. There is a lack of high-quality evidence for current guidelines in management and a need for randomized
controlled trials comparing conservative and interventional management for this condition.
P L A I N L A N G U A G E S U M M A R Y
Observation alone versus drain tube or needle insertion (interventional) for primary spontaneous pneumothorax in adults
without previous lung disease.
Review question: A primary spontaneous pneumothorax (PSP) is a collection of air in the lining of the lung that occurs on its own or
without a traumatic event. When this occurs, people can have chest pain and shortness of breath. Most of the time, the air in the lung
is absorbed by the body and slowly decreases with time. Most of the guidelines in managing this condition recommend draining the
air by sucking it out with a small needle, or placing a larger tube into the chest that drains the air over a period of time (both called
’interventional’ management’). We aimed to examine the evidence for the recommendation.
Background: Interventional management can have side effects, such as causing more pain, infection, and potentially damaging nearby
structures. The other way of treatment is called observational or conservative, where pain relief and extra oxygen are given until the
lung re-inflates and the air is absorbed by the body on its own. Studies that look back on how patients were managed (retrospective
studies) and personal experience of the authors with these patients show that managing them by observation alone can work well.
Review findings: The authors of this review searched for studies that compared interventional management with observational
management but found no completed studies, although there is one study in progress. This means that there is a lack of high-quality
evidence about the best way to manage a primary spontaneous pneumothorax in adults aged over 18 without previous lung disease;
further studies are needed. The evidence is current to 26th June 2014.
Conservative versus interventional management for primary spontaneous pneumothorax in