Can my patient dive after a first episode of primary spontaneous pneumothorax? A systematic review of the literature.

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Patients with prior primary spontaneous pneumothorax (PSP) frequently seek clearance to dive. Despite wide consensus in precluding compressed-air diving in this population, there is a paucity of data to support this decision. We reviewed the literature reporting the risk of PSP recurrence.A literature search was performed in PubMed and Web of Science using predefined terms. Studies published in English reporting the recurrence rate after a first PSP were included.Forty studies (n=3,904) were included. Risk of PSP recurrence ranged 0-67% (22 ± 15.5%; mean ± SD). Mean follow-up was 36 months, and 63 ± 39% of recurrences occurred during the first year of follow-up. Elevated height/weight ratio and emphysema-like changes (ELCs) are associated with PSP recurrence. ELCs are present in 59%-89% (vs. 0-15%) of patients with recurrence and can be detected effectively with high-resolution CT scan (sensitivity of 84-88%). Surgical pleurodesis reduces the risk of recurrence substantially (4.0 ± 4% vs. 22 ± 15.5%).Risk of PSP recurrence seems to decline over time and is associated to certain radiological and clinical risk factors. This could be incremented by the stresses of compressed-air diving. A basis for informed patient-physician discussions regarding future diving is provided in this review.





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Villela, M Alvarez, S Dunworth, NP Harlan and RE Moon (2018). Can my patient dive after a first episode of primary spontaneous pneumothorax? A systematic review of the literature. Undersea & hyperbaric medicine : journal of the Undersea and Hyperbaric Medical Society, Inc, 45(2). pp. 199–208. 10.22462/03.04.2018.7 Retrieved from

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Sophia Dunworth

Assistant Professor of Anesthesiology

Richard Edward Moon

Professor of Anesthesiology

Research interests include the study of cardiorespiratory function in humans during challenging clinical settings including the perioperative period, and exposure to environmental conditions such as diving and high altitude. Studies have included gas exchange during diving, the pathophysiology of high altitude and immersion pulmonary edema, the effect of anesthesia and postoperative analgesia on pulmonary function and monitoring of tissue oxygenation. Ongoing human studies include the effect of respiratory muscle training on chemosensitivity and blood gases during stressful breathing: underwater exercise.

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