Therapy

A small pneumothorax can be observed at first and the spontaneous regression can be accelerated, possibly by nasal oxygenation. A symptomatic pneumothorax, i.e. a pneumothorax that causes health problems for the affected person, can be treated by suctioning the air through a tube. This method is called thoracic drainage with suction.

If there is no complete regression or if the disease recurs, part of the lung tissue can be removed in exceptional cases (pleurectomy). The first step is to select a suitable site on the patient’s chest. There are essentially two locations for the application of a thoracic drainage.

One is located in the area of the middle lateral thorax between the 4th and 5th rib. The drainage introduced here is then called a Bülau drainage. The second option is called Monaldi drainage and is inserted in the upper middle thorax between the 2nd and 3rd ribs.

Before the drainage is applied, which in its function can drain off secretions or blood and air, a local anaesthetic is administered. Then a small skin incision is made with a scalpel and the upper edge of the lower rib is prepared with scissors or pliers. This takes place until the corresponding space, the so-called pleural gap, is reached.

Roughly speaking, this space lies between the chest and the lungs. After the drainage has been placed, it is fixed to the patient with a skin suture and a plaster is applied. The drainage is then connected to a closed system consisting of a water lock and a secretion container, which is placed under suction.

The correct fit and the therapeutic effect of the thoracic drainage are then checked by an X-ray. The decision to remove a thoracic drainage is made by the treating physician after several days of observation. Test phases are carried out repeatedly in which the suction is adjusted to the drainage.

Afterwards, an X-ray is taken to see if there is renewed air or fluid accumulation in the pleural gap. If this is not the case, the drainage can be removed. This is done by applying suction and pulling on the tube.

The existing hole in the skin is then covered with a sterile compress and initially also compressed with a bandage. The drainage was applied for a certain indication, a reason. Once this reason has been eliminated or the triggering factors are minimized, the removal of the drainage can be considered.

Thus, it varies from case to case how long a thoracic drainage must remain in place. After careful consideration, the medical team in the hospital then decides together.When broken down, it can be said that the drainage is drawn if there is no further accumulation of air or fluid in the pleural gap. This is usually the case after a few days.

However, a chest tube can also remain in place for several weeks. Surgical therapy should be considered in the event of repeated complaints associated with a pneumothorax. Even proven weak points in the lung tissue, known as “bulla” (bladder) in technical jargon, should be surgically repaired.

These are thin-skinned, inverted blisters that can burst spontaneously. The scenario of a tension pneumothorax also requires surgical treatment. If the therapy with a thoracic drainage is insufficient and air leaks continue to occur, surgery should also be considered.

In the case of rib fractures, which cause pneumothorax due to splinters or fracture fragments, surgery should be considered to eliminate the problem. In surgery in general, there is overstitching of potential leakage sites or resection of smaller parts of the lung. In addition, a so-called pleurodesis can be helpful to prevent the lung from collapsing. In this procedure, the lung and pleura are glued together. These two skins form the outer boundary of the pleural gap, which lies between the inner thorax and the lung.