The Role of Conservative Management in The Treatment of Large Primary Spontaneous Pneumothorax: Is Pleural Drainage Necessary?

Introduction: There is no definite algorithm for the treatment of first episode primary spontaneous pneumothorax. Although interventional methods are recommended in patients with dyspnea or respiratory distress, conservative treatments are more prominent in patients with non-specific symptoms or asymptomatic patients. In this study we aimed to compare conservative treatment and chest tube application in patients with first-episode large spontaneous pneumothorax without respiratory distress.
Methods: The data of patients who were treated for primary spontaneous pneumothorax in our clinic between February 2022 and December 2022 was reviewed. Patients with first-episode large pneumothorax without respiratory distress were included in the study. Characteristics and follow-up results of the patients were recorded.      
Results: A total of 28 patients who met the criteria were included in the study. The chest tube was applied to 20 of the patients included in the study, and 8 patients were followed up with O2 inhalation without surgical intervention. The mean hospital stay was longer in the chest tube group, while the mean time for lung expansion and the number of outpatient visits after discharge were found to be higher in the conservative group (p=0.014, p=0.00, p=0.015, respectively).
Conclusion: The conservative approach in the treatment of first-episode large primary spontaneous pneumothorax is an alternative to interventional procedures, with a shorter hospital stay and similar recurrence rates in patients without respiratory distress or low oxygen saturation.