Fundacion Jimenez Diaz
Virgen de la Arixaca
Correspondence to: Nuria Manes, MD, FCCP, Thoracic Surgery, Fundacion Jimenez Diaz, Av. Reyes Catolicos, 2, 28040 Madrid, Spain; e-mail: firstname.lastname@example.org or email@example.com
To the Editor.
We read with much interest the American College of Chest
Physicians (ACCP) Delphi Consensus Statement in CHEST
First of all, we would like to express our most sincere admiration to
the group of authors and to the panel of experts referred to in“
Appendix 1” of the article for having been able to carry out such
an arduous task.
We were very surprised that a panel of world experts was able to review
only articles that were published in English. Probably, they could have
come up with more beneficial conclusions if they could have compared
their guidelines with others in other languages, and not just with the
British Thoracic Society guidelines. For instance, the Spanish
guidelines can be obtained either through written publications or
through the Web site of the Scientific Society of Spain (www.separ.es).
The ACCP guidelines are very similar to the Spanish guidelines when the
two are compared. As a point of divergence between the two guidelines,
we can cite differences in the make up of the panel of world experts in
the former article and that of the Spanish panel of experts in the
latter. The Spanish guidelines were drawn up by thoracic surgeons and
pulmonologists, whereas the American guidelines were prepared by
physicians from critical care units, general surgeons, radiologists,
and emergency medicine physicians as well.
The American guidelines offer a detailed form of action in each one of
the primary and secondary cases of spontaneous pneumothorax without
expressing an opinion about the action, only showing the result of the
consensus and allowing readers to come to their own conclusions. The
Spanish guidelines give the final results of the consensus.
Surprisingly, the results are still similar.
On the other hand, knowing the beneficial results for thoracoscopy in
the treatment of pneumothorax, it is still surprising to find that
chemical pleurodesis could be taken into account in the treatment of
spontaneous pneumothorax if no surgical contraindications
It seems that the development of video-imaging techniques has changed
the form of action for treating spontaneous pneumothorax, and not the
development of surgical techniques. Thoracoscopy indicates the
need, first, for surgical treatment, and occasionally the need for
thoracotomy in selected cases.1,3 It is good to
know that we can count on a wide historical experience with this
pathology and its treatment. We join to express the wishes of the panel
of American experts and to collaborate1 in the development
of the prospective studies. It is worthwhile mentioning that
there should be some minimum requirements and adequate training to
carry out such techniques.4 Only in this way could we
improve the results using the selected treatment.
Finally, we would like to congratulate the ACCP Pneumothorax Consensus
Group and the panel of experts for their great accomplishment.
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