When should treatment of a patient with a pneumothorax be considered?
Many pneumothoraces resolve spontaneously, and only patients at risk for complications of the pneumothorax require intervention. Generally, treatment with thoracostomy is necessary if the patient has respiratory compromise as a result of the pneumothorax. Findings such as shortness of breath, dyspnea, hypoxemia, or hypotension indicate the need for drainage of the pneumothorax. If the pneumothorax increases in size on serial chest radiographs, treatment also may become necessary. If clinical and radiographic findings indicate a tension pneumothorax, decompression and drainage of the pneumothorax are necessary. Finally, most patients receiving positive-pressure ventilation require chest tube drainage because of the increased risk of developing a tension pneumothorax.