The utility of oxygen therapy for treating pneumothorax

Hallifax R, et al. (2022). Pneumothorax. In: Broaeddus CV. (Ed.) Murray & Nadel’s Textbook of Respiratory Medicine, 7th ed.

“Evidence from a small study in 1971 suggests that use of 100% oxygen in patients with spontaneous pneumothorax can increase the rate of absorption fourfold compared to air (on the basis of mean reduction in pneumothorax size of 4.8 and 18 cm 2 /day, respectively). The rationale is that by reducing the partial pressure of nitrogen in the inspired gas, and thus in pleural capillaries, the rate of nitrogen absorption from the pneumothorax is increased, thereby increasing the rate of resolution of the pneumothorax.” (p. 1545)


Park CB, et al. Does oxygen therapy increase the resolution rate of primary spontaneous pneumothorax? J Thorac Dis. 2017 Dec;9(12):5239-5243.

“The adverse effects of oxygen therapy in patients with PSP have not been previously investigated. Our study demonstrated the effect of oxygen therapy in the resolution of PSP. The resolution rate was (4.27%±1.97%)/day in the O2 group vs. (2.06%±0.97%)/day in the room air group (Table 1). Although the difference between these rates is statistically significant, its clinical usefulness is uncertain for the following reasons. First, the absolute difference in resolution rate is not great. Second, PSP is also resolved in room air. Third, oxygen therapy has potential adverse effects. Fourth, patients with small pneumothoraces usually maintain adequate oxygenation without oxygen therapy.” (p. 5242)


8.11.6 Pneumothorax

“As with pleural effusions, patients with a large pneumothorax may be breathless and hypoxaemic and may require supplementary oxygen for symptom relief pending definitive treatment by aspiration or drainage. However, high concentration inhaled oxygen can also increase the rate of reabsorption of air from a pneumothorax up to fourfold. For this reason, the BTS guideline on the management of pneumothorax recommends the use of high concentration oxygen (reservoir mask) in all non-COPD patients who require hospital admission for observation due to a moderate-sized pneumothorax that does not require drainage. Once a pneumothorax is drained or aspirated successfully, the patient should not require oxygen therapy unless there is additional pathology such as pneumonia, asthma or COPD requiring specific treatment.”

Recommendations:

  • In most cases of pneumothorax, aim at an oxygen saturation of 94–98% if the patient is at risk of hypercapnic respiratory failure. [Evidence level: Grade D]
  • In patients having hospital observation without drainage, the use of high concentration oxygen (15 l/min flow rate via reservoir mask) is recommended. [Evidence level: Grade C]

From: Management of spontaneous pneumothorax: British Thoracic Society pleural disease guideline 2010.


See also:

Northfield TC. Oxygen therapy for spontaneous pneumothorax. Br Med J. 1971 Oct 9; 4(5779):86-8.

Chadha TS, Cohn MA. Noninvasive treatment of pneumothorax with oxygen inhalation. Respiration. 1983;44(2):147-52.

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