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

Steven Walker^{1

2}, Robert Hallifax^{3

4}, Sara Ricciardi^{5

6}, Deirdre Fitzgerald^{7

8}, Marlies Keijzers⁹, Olivia Lauk¹⁰, Jesper Petersen¹¹, Luca Bertolaccini¹², Uffe Bodtger¹¹, Amelia Clive¹³, Stefano Elia^{14

15}, Marios Froudarakis^{16

17}, Julius Janssen¹⁸, Y C Gary Lee^{7

8}, Peter Licht¹⁹, Gilbert Massard²⁰, Blin Nagavci²¹, Jens Neudecker^{22

23}, Eric Roessner²⁴, Paul Van Schil²⁵, David Waller²⁶, Thorsten Walles²⁷, Giuseppe Cardillo^{5

6

28

29}, Nick Maskell^{30

13

29}, Najib Rahman^{3

4

31

32

29}

Affiliations

¹ Academic Respiratory Unit, Southmead Hospital, Bristol, UK steven.walker@bristol.ac.uk.
² Junior Chair of the Task Force.
³ Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Trust, Oxford, UK.
⁴ Oxford Respiratory Trials Unit, University of Oxford, Oxford, UK.
⁵ Unit of Thoracic Surgery, Azienda Ospedaliera San Camillo Forlanini, Rome, Italy.
⁶ Alma Mater Studiorum, University of Bologna, Bologna, Italy.
⁷ Pleural Medicine Unit, Institute for Respiratory Health, Perth, Australia.
⁸ Medical School and Centre for Respiratory Health, University of Western Australia, Perth, Australia.
⁹ Department of Surgery, Maxima Medical Center, Veldhoven, The Netherlands.
¹⁰ Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland.
¹¹ Respiratory Research Unit PLUZ, Department of Respiratory Medicine Zealand, University Hospital, Naestved, Denmark.
¹² Division of Thoracic Surgery IEO, European Institute of Oncology IRCCS, Milan, Italy.
¹³ North Bristol Lung Centre, Southmead Hospital, Bristol, UK.
¹⁴ Department of Medicine and Health Sciences "V. Tiberio", University of Molise, Campobasso, Italy.
¹⁵ Thoracic Surgical Oncology Programme, Tor Vergata University Hospital, Rome, Italy.
¹⁶ Medical School, Democritus University of Thrace, Alexandroupolis, Greece.
¹⁷ Medical School, University Jean Monnet, Saint Etienne, France.
¹⁸ Department of Pulmonology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands.
¹⁹ Department of Cardiothoracic Surgery, Odense University Hospital, Odense, Denmark.
²⁰ Department of Thoracic Surgery, University of Luxembourg, Hôpitaux Robert Schuman, Luxembourg, Luxembourg.
²¹ Institute for Evidence in Medicine, University Medical Center Freiburg, Freiburg, Germany.
²² Competence Center for Thoracic Surgery, Charité - Universitätsmedizin, Berlin, Germany.
²³ Department of Surgery, Campus Charité Mitte, Campus Virchow-Klinikum, Berlin, Germany.
²⁴ Department of Thoracic Surgery, Center for Thoracic Diseases, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.
²⁵ Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Edegem, Belgium.
²⁶ Thorax Centre, St Bartholomew's Hospital, London, UK.
²⁷ Clinic for Cardiac and Thoracic Surgery, Magdeburg University Hospital, Magdeburg, Germany.
²⁸ Unicamillus - International University of Health Sciences, Rome, Italy.
²⁹ Senior Chairs of the Task Force.
³⁰ Academic Respiratory Unit, Southmead Hospital, Bristol, UK.
³¹ Oxford NIHR Biomedical Research Centre, Oxford, UK.
³² Chinese Academy of Medical Sciences Oxford Institute, Oxford, UK.

PMID: 38806203
DOI: 10.1183/13993003.00797-2023

Practice Guideline

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

Steven Walker et al. Eur Respir J. 2024.

. 2024 May 28;63(5):2300797.

doi: 10.1183/13993003.00797-2023. Print 2024 May.

Authors

Affiliations

¹ Academic Respiratory Unit, Southmead Hospital, Bristol, UK steven.walker@bristol.ac.uk.
² Junior Chair of the Task Force.
³ Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Trust, Oxford, UK.
⁴ Oxford Respiratory Trials Unit, University of Oxford, Oxford, UK.
⁵ Unit of Thoracic Surgery, Azienda Ospedaliera San Camillo Forlanini, Rome, Italy.
⁶ Alma Mater Studiorum, University of Bologna, Bologna, Italy.
⁷ Pleural Medicine Unit, Institute for Respiratory Health, Perth, Australia.
⁸ Medical School and Centre for Respiratory Health, University of Western Australia, Perth, Australia.
⁹ Department of Surgery, Maxima Medical Center, Veldhoven, The Netherlands.
¹⁰ Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland.
¹¹ Respiratory Research Unit PLUZ, Department of Respiratory Medicine Zealand, University Hospital, Naestved, Denmark.
¹² Division of Thoracic Surgery IEO, European Institute of Oncology IRCCS, Milan, Italy.
¹³ North Bristol Lung Centre, Southmead Hospital, Bristol, UK.
¹⁴ Department of Medicine and Health Sciences "V. Tiberio", University of Molise, Campobasso, Italy.
¹⁵ Thoracic Surgical Oncology Programme, Tor Vergata University Hospital, Rome, Italy.
¹⁶ Medical School, Democritus University of Thrace, Alexandroupolis, Greece.
¹⁷ Medical School, University Jean Monnet, Saint Etienne, France.
¹⁸ Department of Pulmonology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands.
¹⁹ Department of Cardiothoracic Surgery, Odense University Hospital, Odense, Denmark.
²⁰ Department of Thoracic Surgery, University of Luxembourg, Hôpitaux Robert Schuman, Luxembourg, Luxembourg.
²¹ Institute for Evidence in Medicine, University Medical Center Freiburg, Freiburg, Germany.
²² Competence Center for Thoracic Surgery, Charité - Universitätsmedizin, Berlin, Germany.
²³ Department of Surgery, Campus Charité Mitte, Campus Virchow-Klinikum, Berlin, Germany.
²⁴ Department of Thoracic Surgery, Center for Thoracic Diseases, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.
²⁵ Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Edegem, Belgium.
²⁶ Thorax Centre, St Bartholomew's Hospital, London, UK.
²⁷ Clinic for Cardiac and Thoracic Surgery, Magdeburg University Hospital, Magdeburg, Germany.
²⁸ Unicamillus - International University of Health Sciences, Rome, Italy.
²⁹ Senior Chairs of the Task Force.
³⁰ Academic Respiratory Unit, Southmead Hospital, Bristol, UK.
³¹ Oxford NIHR Biomedical Research Centre, Oxford, UK.
³² Chinese Academy of Medical Sciences Oxford Institute, Oxford, UK.

PMID: 38806203
DOI: 10.1183/13993003.00797-2023

Abstract

Background: 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 of Recommendations, Assessment, Development and Evaluations). 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.

This article has been co-published with permission in the European Journal of Cardio-Thoracic Surgery and in the European Respiratory Journal. Copyright ©The Author(s) 2024. Published by European Respiratory Society. All rights reserved. The articles are identical except for minor stylistic and spelling differences in keeping with each journal's style. Either citation can be used when citing this article. For reproduction rights and permissions contact permissions@ersnet.org.

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Conflict of interest statement

Conflict of interest: R. Hallifax has received consulting fees from Rocket Medical UK and Cook Medical, and honoraria for educational talks from AstraZeneca. M. Keijzers has received consulting fees from Philips. Y.C.G. Lee received drainage kits from Rocket Medical PLC for patients participating in clinical trials. P. Licht has received personal honoraria from Ethicon and Johnson & Johnson. N. Maskell has received consulting fees and device support for clinical trials from Rocket Medical UK and BD. B. Nagavci acted as ERS methodologist. E. Roessner has received consultancy fees from Rivolution, lecture fees from Siemens Healthineers and AstraZeneca, and was Thoracic Domain chair, Council member and Task Force member of the Solitary Pulmonary Nodules Task Force for EACTS. N. Rahman has received consulting fees Rocket Medical UK and Cook Medical, and has received device support for clinical trials from Rocket Medical UK. P. Van Schil has received personal payments from BMS and Roche, institutional payment from Janssen, MSD and AstraZeneca, and is the treasurer of BACTS (Belgian Association for Cardiothoracic Surgery) and president-elect for IASLC (International Association for the Study of Lung Cancer). D. Waller has received lecture fees from Pulmonx and Medtronic. T. Walles has received a grant (WA 1649/5-2) for clinical study on surgical therapy for treatment of primary pneumothorax from the German Research Foundation, and is an assessor (unpaid) for the German Society of Thoracic Surgery. The remaining authors have no potential conflicts of interest to disclose.

Comment in

Debunking the myth: why wall suction should not be routine in pneumothorax treatment.
Tournoy IS, Tournoy KG. Tournoy IS, et al. Eur Respir J. 2024 Sep 26;64(3):2401215. doi: 10.1183/13993003.01215-2024. Print 2024 Sep. Eur Respir J. 2024. PMID: 39326904 No abstract available.
Reply: Guideline recommendations don't exist in a vacuum.
Walker S, Hallifax R, Rahman N, Maskell N. Walker S, et al. Eur Respir J. 2024 Sep 26;64(3):2401421. doi: 10.1183/13993003.01421-2024. Print 2024 Sep. Eur Respir J. 2024. PMID: 39326906 Free PMC article.

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

Affiliations

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

Authors

Affiliations

Abstract

Conflict of interest statement

Comment in

Publication types

MeSH terms

LinkOut - more resources

Full Text Sources

Medical

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