The use of high concentrations of inspired oxygen seems to be a time-honored technique for trying to avoid chest tube insertion for pneumothorax. But does it stand up to scrutiny, or is this just an urban legend?
This recommendation is based upon a single case report involving 8 patients in 1983! Six patients with a pneumothorax of less than 30% showed a decrease in size of 4.2% per day on average. The two patients with pneumothoraces larger than 30% did not respond. A response was only seen with oxygen administered by a partial nonrebreather mask, not by nasal cannula.
What’s the problem? First, this is a very small case report. There were no controls, so it is entirely possible that the resolution rate without treatment was the same as that seen in this report. Furthermore, this study was performed prior to the availability of chest CT. Therefore, the true size of the pneumothoraces is only a guess since volumetric calculations could not be performed. It is not possible to distinguish a 4% change in the size of a pneumothorax by regular chest xray (click here for more details).
The bottom line: If the patient needs supplemental oxygen for management of other pulmonary conditions, then administer it. It is not indicated as an independent treatment for pneumothorax, and its use for this condition should be abandoned!
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Reference: Noninvasive treatment of pneumothorax with oxygen inhalation. Chadha TS. Respiration 44(2):147-52, 1983
