Prognosis
Primary spontaneous pneumothorax
Patients with primary spontaneous pneumothoraces are at risk for recurrent pneumothoraces. Between 30% and 50% of patients will have an ipsilateral recurrent pneumothorax. Unless an intervention is undertaken in a patient with a first recurrence, a third and fourth event can be expected in 62% and 83% of patients, respectively. These patients are also at risk of a contralateral primary spontaneous pneumothorax.[105]
The recurrence rates of primary spontaneous pneumothorax after video-assisted thoracoscopy with stapling of the subpleural bleb and mechanical pleural abrasion and thoracoscopic talc poudrage are similar (approximately 5%). Chemical pleurodesis can be accomplished via chest tube if video-assisted thoracoscopy is not readily available, or if the patient refuses video-assisted thoracoscopy. The failure rate of chemical pleurodesis is approximately 25%.[17] Additionally, autologous blood patch and endobronchial valve placement can be considered.[106][107]
Secondary spontaneous pneumothorax
Patients with secondary spontaneous pneumothoraces are at greater risk of recurrences. Because many lung diseases occur bilaterally, these patients are typically at risk for contralateral secondary spontaneous pneumothoraces.[108] The intervention taken for a persistent air leak or a recurrent ipsilateral pneumothorax may depend on available resources.
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