Pneumothorax – BTS 2023

To drain or not to drain? – that is the question (Follow the BTS algorithm).This is not for Tension!

(All treatment options should be discussed with the patient to determine their main priority, with consideration for the least invasive option)

BTS 2023

Note: Primary Spontaneous Pneumothorax (PSP), Secondary Spontaneous Pneumothorax (SSP) i.e. patient has underlying lung conditions

Treatment options:

Conservative Management

  • Considered for the treatment of minimally symptomatic (ie, no significant pain or breathlessness and no physiological compromise) or asymptomatic primary spontaneous pneumothorax in adults regardless of size.
  • This option requires:
    • Intensive FU through mSDEC/Respiratory Clinic initially in Primary Spontaneous Pneumothorax (PSP)
    • Inpatient admission in Secondary Spontaneous Pneumothorax (SSP)

Needle Aspiration

Large pneumothorax consider placing a Seldinger drain instead of needle aspiration.

  • Its small and no more painful
  • Measure volume removed (counting 50ml syringes)
  • Turn off while awaiting CXR
  • Drained?
    • Enough – can remove
    • Not enough – can then connect to seal and open

Ambulatory Device

Currently this is not an option at CHT

Other Conditions to Consider

  • Pregnancy – More common in pregnancy – and best treated in most minimally invasive as possible.
  • Catamenial(menses related) – Under diagnosed and requires surgical intervention and hormonal manipulation (after initial therapy)
  • Cystic Fibrosis – Treat as secondary but early consideration of surgical treatment advised
  • AIDS – Treat as secondary but early consideration od HIV treatment and surgical intervention


  • Ensure Follow up arranged either through Respiratory Clinic / mSDEC
  • Discharge advice [ensure documented in notes & Advice sheet given]
    • Increased Symptoms – Immediate return to ED
    • Flight – None until full resolution confirmed
    • Diving – None until Bilateral Pleurodectomy and Normal FU CT


PDF:BTS 2023

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