Academic Respiratory Unit, Southmead Hospital, Bristol, UK.
Junior Chair of the Task Force.
Eur J Cardiothorac Surg. 2024 May 3;65(5). doi: 10.1093/ejcts/ezae189.
The optimal management for spontaneous pneumothorax (SP) remains contentious, with various proposed approaches. This joint clinical practice guideline from the ERS, EACTS and ESTS societies provides evidence-based recommendations for the management of SP.
This multidisciplinary Task Force addressed 12 key clinical questions on the management of pneumothorax, using ERS methodology for guideline development. Systematic searches were performed in MEDLINE and Embase. Evidence was synthesised by conducting meta-analyses, if possible, or narratively. Certainty of evidence was rated with GRADE (Grading, Recommendation, Assessment, Development and Evaluation). The Evidence to Decision framework was used to decide on the direction and strength of the recommendations.
The panel makes a conditional recommendation for conservative care of minimally symptomatic patients with primary spontaneous pneumothorax (PSP) who are clinically stable. We make a strong recommendation for needle aspiration over chest tube drain for initial PSP treatment. We make a conditional recommendation for ambulatory management for initial PSP treatment. We make a conditional recommendation for early surgical intervention for the initial treatment of PSP in patients who prioritise recurrence prevention. The panel makes a conditional recommendation for autologous blood patch in secondary SP patients with persistent air leak (PAL). The panel could not make recommendations for other interventions, including bronchial valves, suction, pleurodesis in addition to surgical resection or type of surgical pleurodesis.
With this international guideline, the ERS, EACTS and ESTS societies provide clinical practice recommendations for SP management. We highlight evidence gaps for the management of PAL and recurrence prevention, with research recommendations made.
This update of an ERS Task Force statement from 2015 provides a concise comprehensive update of the literature base. 24 evidence-based recommendations were made for management of pneumothorax, balancing clinical priorities and patient views.https://bit.ly/3TKGp9e.
自发性气胸（SP）的最佳治疗方法仍存在争议，有各种不同的方法。ERS、EACTS 和 ESTS 学会联合发布的本临床实践指南为 SP 的治疗提供了循证推荐意见。
这个多学科工作组针对气胸管理的 12 个关键临床问题，使用 ERS 指南制定方法进行了研究。在 MEDLINE 和 Embase 中进行了系统搜索。如果可能的话，通过进行荟萃分析来综合证据，并进行叙述性分析。使用 GRADE（分级、推荐、评估、发展和评估）对证据的确定性进行评级。使用证据决策框架来确定建议的方向和力度。
专家组对临床稳定的原发性自发性气胸（PSP）症状轻微的患者进行保守治疗提出了有条件的推荐意见。我们强烈推荐在初次 PSP 治疗中使用针吸而非胸腔引流管。我们对初次 PSP 治疗的门诊管理提出了有条件的推荐意见。我们对优先预防复发的 PSP 患者的初始治疗提出了早期手术干预的有条件推荐意见。专家组对持续性漏气（PAL）的继发性 SP 患者使用自体血贴提出了有条件的推荐意见。专家组无法对其他干预措施（包括支气管镜瓣膜、抽吸、胸膜固定术以及手术切除或胸膜固定术的类型）提出建议。
ERS、EACTS 和 ESTS 学会通过本国际指南为 SP 管理提供了临床实践建议。我们强调了 PAL 和预防复发管理方面的证据空白，并提出了研究建议。
本 ERS 工作组 2015 年声明的更新提供了对文献基础的简明综合更新。为管理气胸，平衡临床重点和患者观点，提出了 24 项基于证据的推荐意见。https://bit.ly/3TKGp9e。
