SPLF/SMFU/SRLF/SFAR/SFCTCV Guidelines for the management of patients with primary spontaneous pneumothorax: Endorsed by the French Speaking Society of Respiratory Diseases (SPLF), the French Society of Emergency Medicine (SFMU), the French Intensive Care Society (SRLF), the French Society of Anesthesia & Intensive Care Medicine (SFAR) and the French Society of Thoracic and Cardiovascular Surgery (SFCTCV).

Primary spontaneous pneumothorax (PSP) is the presence of air in the pleural space, occurring in the absence of trauma and known lung disease. Standardized expert guidelines on PSP are needed due to the variety of diagnostic methods, therapeutic strategies and medical and surgical disciplines involved in its management. Literature review, analysis of literature according to the GRADE (Grading of Recommendation Assessment, Development and Evaluation) methodology; proposals for guidelines rated by experts, patients, and organizers to reach a consensus. Only expert opinions with strong agreement were selected. A large PSP is defined as presence of a visible rim along the entire axillary line between the lung margin and the chest wall and ≥2 cm at the hilum level on frontal chest x-ray. The therapeutic strategy depends on the clinical presentation: emergency needle aspiration for tension PSP; in the absence of signs of severity: conservative management (small PSP), needle aspiration or chest tube drainage (large PSP). Outpatient treatment is possible if a dedicated outpatient care system is previously organized. Indications, surgical procedures and perioperative analgesia are detailed. Associated measures, including smoking cessation, are described. These guidelines are a step towards PSP treatment and follow-up strategy optimization in France.

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Déclaration de conflit d'intérêts

Declaration of interests other than PSP Stéphane Jouneau received fees, research project funding, reimbursements for national or international congresses, participated in clinical studies or expert panels for the following laboratories (or similar): AIRB, Biogen, Boehringer Ingelheim, BMS, Fibrogen, Galecto Biotech, Genzyme-Sanofi, Gilead, LVL, Novartis, Pfizer, Pliant Therapeutics, Roche, Sanofi, Savara. Agathe Seguin-Givelet received fees and participated in expert panels for the following laboratories (or similar): AstraZeneca, AMGEN, Intuitive and Medtronic. Naïke Bigé received fees and reimbursements for national or international congresses from Sanofi. Jonathan Messika received reimbursements for conference fees from CSL Behring and Biotest. Elise Noel-Savina received fees, reimbursements for national or international congresses, participated in clinical studies or expert panels for the following laboratories (or similar): Boehringer Ingelheim, Novartis, Pfizer, GSK, Astra Zeneca, Janssen and MSD. Nicolas Roche received fees and funding (expert panels, consulting, training, conferences, participation in congresses, research projects) from the following laboratories: Boehringer Ingelheim, Novartis, Pfizer, GSK, MSD, AstraZeneca, Chiesi, Sanofi, Zambon. Mikaël Martinez received personal payments for participating in an expert panel from AstraZeneca. The other authors also declare having no interest other than PSP.