Pneumothorax spontané idiopathique : exsufflation ou drainage ?

In France, spontaneous pneumothoraxes represent 78% of cases of pneumothorax in emergency units. The severity of pneumothorax varies from simple apical pneumothorax, to compressive suffocating pneumothorax. Treatment methods are multiple (abstention, monitoring, exsufflation, thoracic drainage, and thoracic surgery) with different treatment issues for the physician (recognized indication, feasibility and ease of technique, benefit/risk balance) and the patient (pain, efficiency, hospitalization). The indication of the first-line treatment of spontaneous pneumothorax is still not consensual between the thoracic drainage and the exsufflation. Although exsufflation is an efficient method, easy, simple, reproducible and with an economic benefit (length of stay) and recommended by BTS (British Thoracic Society), it is still rarely used in the treatment of spontaneous pneumothorax unlike conventional chest tube drainage which is associated with higher costs and more complications. The reasons for this limited use are the lack of: literature data, consensus and technical training of physicians. The EXPRED study, a prospective, randomized trial evaluating exsufflation versus drainage in first-line treatment of primary spontaneous pneumothorax, is underway.