Treatment of Spontaneous Pneumothorax by Means of Continuous Intrapleural Suction

¹ Resident in Surgery, U. S. Veterans Administration Hospital, San Francisco, California.
² Chief of Surgical Service, U. S. Veterans Administration Hospital, San Francisco; Assistant Clinical Professor of Surgery, University of California Hospital, San Francisco, California.
³ Consultant in Thoracic Surgery, U. S. Veterans Administration Hospital, San Francisco; Chief of Staff, French Hospital, San Francisco, California.

A method of obtaining constant negative intrapleural suction of any desired amount is described. Its application in the treatment of 10 patients with spontaneous pneumothorax is presented. Nine of the 10 patients have had no recurrence of the pneumothorax. One had a recurrence and died because of a combination of the pneumothorax, generalized pulmonary emphysema with bullous emphysema, and hematemesis from esophageal varices before the lung could be reexpanded a second time. It could not be considered a fatality from the method itself. None of the patients developed any permanent deleterious after-effects from the continuous intrapleural suction. Cultures of pleural fluid during the time of continuous intrapleural suction showed no bacterial growth.

While it is true that the majority of lungs collapsed by spontaneous pneumothorax will expand with no treatment except limitation of activity, it is also true that the time of expansion is several weeks and if the collapse is over 50 per cent it may run well over six weeks, representing a substantial economic loss to the patient. The high percentage of recurrences adds weight to our belief that expectant treatment may not be the treatment of choice even in simple spontaneous pneumothorax.