Service de Pneumologie, Centre de Compétences pour les Maladies Pulmonaires Rares, IRSET UMR 1085, Université de Rennes 1, Hôpital Pontchaillou, 2 rue Henri Le Guilloux, 35033 Rennes Cedex 9, Rennes 35033, France.
Université Paris Cité, AP-HP, DMU ESPRIT, Service de Médecine Intensive Réanimation, Hôpital Louis Mourier, 178 Rue des Renouillers, 92700 Colombes ; INSERM IAME U1137, Paris, France.
Respir Med Res. 2023 Jun;83:100999. doi: 10.1016/j.resmer.2023.100999. Epub 2023 Mar 30.
Primary spontaneous pneumothorax (PSP) is the presence of air in the pleural space, occurring in the absence of trauma and known lung disease. Standardized expert guidelines on PSP are needed due to the variety of diagnostic methods, therapeutic strategies and medical and surgical disciplines involved in its management.
Literature review, analysis of literature according to the GRADE (Grading of Recommendation Assessment, Development and Evaluation) methodology; proposals for guidelines rated by experts, patients, and organizers to reach a consensus. Only expert opinions with strong agreement were selected.
A large PSP is defined as presence of a visible rim along the entire axillary line between the lung margin and the chest wall and ≥2 cm at the hilum level on frontal chest x-ray. The therapeutic strategy depends on the clinical presentation: emergency needle aspiration for tension PSP; in the absence of signs of severity: conservative management (small PSP), needle aspiration or chest tube drainage (large PSP). Outpatient treatment is possible if a dedicated outpatient care system is previously organized. Indications, surgical procedures and perioperative analgesia are detailed. Associated measures, including smoking cessation, are described.
These guidelines are a step towards PSP treatment and follow-up strategy optimization in France.
原发性自发性气胸（PSP）是指胸膜腔内存在空气，发生在没有创伤和已知肺部疾病的情况下。由于 PSP 的管理涉及多种诊断方法、治疗策略以及医疗和外科专业，因此需要制定标准化的专家指南。
文献回顾，根据 GRADE（推荐评估、制定与评估分级）方法分析文献；对指南建议进行专家、患者和组织者评估，以达成共识。仅选择具有强烈一致性的专家意见。
大型 PSP 定义为在前胸 X 光片上，整个腋前线的肺部边缘和胸壁之间存在可见的边缘，并且在隆突水平≥2cm。治疗策略取决于临床表现：张力性 PSP 行紧急针吸；无严重迹象时：保守治疗（小型 PSP），针吸或胸腔引流管引流（大型 PSP）。如果事先组织了专门的门诊护理系统，则可以进行门诊治疗。详细介绍了适应证、手术程序和围手术期镇痛。还描述了包括戒烟在内的相关措施。
这些指南是法国 PSP 治疗和随访策略优化的一个步骤。
