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Vol. 44. Issue 8.
Pages 437-448 (January 2008)
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Vol. 44. Issue 8.
Pages 437-448 (January 2008)
Recommendations of the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR)
DOI: 10.1016/S1579-2129(08)60077-4
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Guidelines for the Diagnosis and Treatment of Spontaneous Pneumothorax
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Juan J. Rivas de Andrésa,
Corresponding author
jjrivas@jet.es

Correspondence: Dr. J.J. Rivas Servicio de Cirugía Torácica de Aragón Hospital Universitario Miguel Servet Paseo de Isabel la Católica, 1-3 50009 Zaragoza, Spain Correo electrónico
, Marcelo F. Jiménez Lópezb, Laureano Molins López-Rodóc, Alfonso Pérez Trullénd, Juan Torres Lanzase
a Servicio de Cirugía Torácica de Aragón, Hospital Universitario Miguel Servet, Zaragoza, Spain
b Servicio de Cirugía Torácica, Hospital Universitario, Salamanca, Spain
c Servicio de Cirugía Torácica, Hospital Universitari Sagrat Cor, Barcelona, Spain
d Servicio de Neumología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
e Servicio de Cirugía Torácica, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
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This is the fourth update of the guidelines for the diagnosis and treatment of pneumothorax published by the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR).

Spontaneous pneumothorax, or the presence of air in the pleural space not caused by injury or medical intervention, is a significant clinical problem. We propose a method for classifying cases into 3 categories: partial, complete, and complete with total lung collapse. This classification, together with a clinical assessment, would provide sufficient information to enable physicians to decide on an approach to treatment.

This update introduces simple aspiration in an outpatient setting as a treatment option that has yielded results comparable to conventional drainage in the management of uncomplicated primary spontaneous pneumothorax; this technique is not, as yet, widely used in Spain.

For the definitive treatment of primary spontaneous pneumothorax, the technique most often used by thoracic surgeons is video-assisted thoracoscopic bullectomy and pleural abrasion.

Hospitalization and conventional tube drainage is recommended for the treatment of secondary spontaneous pneumothorax.

This update also has a new section on catamenial pneumothorax, a condition that is probably underdiagnosed.

The definitive treatment for a recurring or persistent air leak is usually surgery or the application of talc through the drainage tube when surgery is contraindicated.

Our aim in proposing treatment algorithms for the management of pneumothorax in these guidelines was to provide a useful tool for clinicians involved in the diagnosis and treatment of this disease.

Key words:
Spontaneous pneumothorax
Bullae
simple aspiration
Chest drainage
Video-assisted thoracoscopy
Treatment

Se presenta la cuarta puesta al día de la “Normativa sobre diagnóstico y tratamiento del neumotórax”, de la Sociedad Española de Neumología y Cirugía Torácica (SEPAR).

La presencia de aire dentro de la cavidad pleural de causa no traumática o iatrógena es un problema clínico relevante. Se propone un método de cuantificación del neumotórax mediante su clasificación en parcial, completo o total, que junto a la valoración clínica parece suficiente para adoptar las diversas actitudes terapéuticas.

En la presente actualización se incorpora la aspiración simple ambulatoria, como método equiparable en resultados al drenaje convencional, para el tratamiento del neumotórax espontáneo primario no complicado, cuyo uso no está todavía muy extendido en España.

Para el tratamiento definitivo del neumotórax espontáneo primario, la cirugía videotoracoscópica con bullectomía y abrasión pleural es la técnica más ampliamente utilizada por la mayoría de cirujanos torácicos.

En el tratamiento del neumotórax espontáneo secundario se recomienda el ingreso y la colocación de drenaje torácico convencional.

Se ha introducido también una referencia al neumotórax catamenial, probablemente infradiagnosticado.

En caso de recidiva o fuga aérea persistente, el tratamiento definitivo suele ser el quirúrgico o el uso de talco a través del drenaje en caso de contraindicación.

Los algoritmos de estrategia terapéutica aquí propuestos pretenden convertirse en una herramienta de trabajo útil para todos los implicados en el diagnóstico y tratamiento de esta enfermedad.

Palabras clave:
Neumotórax espontáneo
Bullas
Aspiración simple
Drenaje torácico
Videotoracoscopia
Tratamiento
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