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Communications to the Editor |

Pneumothorax—Guidelines of Action FREE TO VIEW

Nuria Manes, MD, FCCP; Helena Hernandez-Rodriguez, MD; Soledad Lopez-Martin, MD; Fernando Sanchez-Gascon, MD
Author and Funding Information

Fundacion Jimenez Diaz Madrid, Spain Virgen de la Arixaca Murcia, Spain

Correspondence to: Nuria Manes, MD, FCCP, Thoracic Surgery, Fundacion Jimenez Diaz, Av. Reyes Catolicos, 2, 28040 Madrid, Spain; e-mail: nmanes@separ.es or nmanes@fjd.es



Chest. 2002;121(2):669. doi:10.1378/chest.121.2.669
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Published online

To the Editor.

We read with much interest the American College of Chest Physicians (ACCP) Delphi Consensus Statement in CHEST (February 2001).1

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 exist.2

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.

References

Baumann, MH, Strange, C, Heffner, JE, et al (2001) Management of spontaneous pneumothorax: an American College of Chest Physicians Delphi Consensus Statement; the ACCP Pneumothorax Consensus Group.Chest119,590-602. [PubMed] [CrossRef]
 
Baumann, MH Treatment of spontaneous pneumothorax.Curr Opin Pulm Med2000;6,275-280. [PubMed]
 
Grupo de Trabajo Separ. Normativa sobre diagnóstico y tratamiento del neumotorax.Arch Bronconeumol1995;31,339-345. [PubMed]
 
Canalis, E, Castella, J, Diaz, P, et al Requisitos mímimis para una Unidad de Endoscopia Respiratoria: Area de Técnicas Diagnósticas y Terapéuticas.Arch Bronconeumol1997;33,92-98. [PubMed]
 

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References

Baumann, MH, Strange, C, Heffner, JE, et al (2001) Management of spontaneous pneumothorax: an American College of Chest Physicians Delphi Consensus Statement; the ACCP Pneumothorax Consensus Group.Chest119,590-602. [PubMed] [CrossRef]
 
Baumann, MH Treatment of spontaneous pneumothorax.Curr Opin Pulm Med2000;6,275-280. [PubMed]
 
Grupo de Trabajo Separ. Normativa sobre diagnóstico y tratamiento del neumotorax.Arch Bronconeumol1995;31,339-345. [PubMed]
 
Canalis, E, Castella, J, Diaz, P, et al Requisitos mímimis para una Unidad de Endoscopia Respiratoria: Area de Técnicas Diagnósticas y Terapéuticas.Arch Bronconeumol1997;33,92-98. [PubMed]
 
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