Multidisciplinary team to explore new approaches in managing pneumothorax

Kamran Mahmood, MD, MPH
Kamran Mahmood, MD, MPH

The management of pneumothorax and persistent air leak is changing more quickly than clinical guidelines. A special panel discussion at CHEST 2022 will explore current approaches to pneumothorax and persistent air leak from a multidisciplinary perspective.

“The problem of pneumothorax has been written about for centuries,” said Kamran Mahmood, MD, MPH, associate professor of medicine and co-director of bronchoscopy at Duke University Medical Center. “The guidelines to manage pneumothorax are outdated and there is a diversity of opinions about how to manage this, so patients are getting variable care, even within the same institutions, in the hands of different experts. This leads to outcomes that are not optimal.”

Dr. Mahmood will chair a discussion exploring the latest Updates in the Management of Pneumothorax and Persistent Air Leak on Wednesday, October 19, from 3:30 PM – 4:30 PM CT in Room 103ABC. The panel will include two interventional pulmonologists, a thoracic surgeon, and a nurse practitioner.

“Getting a multidisciplinary team of experts on the same panel, with an opportunity to ask questions about different approaches, is unfortunately not readily accessible to a lot of clinicians,” Dr. Mahmood said. “And when it comes to issues like whether all pneumothoraces need to be drained, the best approach to pleurodesis, etc, there will be a heated discussion.”

In the absence of up-to-date guidelines, there is an increasingly aggressive trend in draining small pockets of pneumothorax, he noted. More recent data suggest that it may be both possible and appropriate to manage pneumothoraces without inserting a chest tube in certain clinical situations.

He added that aggressive attempts to drain even small pneumothorax have led to intraparenchymal chest tube placement, unnecessary hospitalizations, and prolonged institutional stays. There is also a need to discuss outpatient management options for patients with pneumothorax and chest drains.

Similarly, the management of persistent air leak has changed significantly in the last 10-15 years since the last CHEST and British Thoracic Society guidelines were published. There is a pressing clinical need to revisit the definition of a persistent air leak and discuss the approaches offered by both interventional pulmonologists and by thoracic surgeons.

“New guidelines are in the pipeline,” Dr. Mahmood added, “but in the meantime, we want to get a group of experts together and come up with an evidence-based, multidisciplinary consensus about the best practices for managing pneumothorax.”