Pneumothorax size versus chest drain size, does it make a difference? What actually happened

The BTS guidelines (2010) suggest initial needle aspiration for small pneumothoraces ( To determine whether the size of drain required to effectively treat a pneumothorax is dependent on pneumothorax size. Patients who presented with pneumothorax were audited over a six month period. Size of pneumothorax, clinical stability, primary or secondary causation, size of drain(s) inserted, whether patient responded to treatment or required a further drain, suction or surgical intervention were recorded. 17 Patients were audited. 29.4% had primary spontaneous pneumothorax. Mean pneumothorax size was 53.4mm. 14 of the 17 patients (76.4%) initially had a 12Ch seldinger drain inserted. Regardless of the initial size of catheter, 47% of patients required either insertion of a larger chest drain (>18Ch), with 29.5% requiring cardiothoracic referral for definitive surgical procedure. Of those who required either larger drain insertion or surgery, only one (14%) was a primary pneumothorax, but there was no significant difference in the size of the presenting pneumothorax (54.55mm vs 53.90) Size of initial pneumothorax did not affect the resolution of the pneumothorax. Patients with a secondary pneumothorax are more likely to require either the insertion of a larger drain, or cardiothoracic intervention. This would support the use of smaller seldinger catheters in patients with primary spontaneous pneumothorax who require intervention given the lower rate of complication.