{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T14:38:10Z","timestamp":1792075090133,"version":"4.4.0"},"reference-count":35,"publisher":"MDPI AG","issue":"13","license":[{"start":{"date-parts":[[2023,6,27]],"date-time":"2023-06-27T00:00:00Z","timestamp":1687824000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Following current guidelines, spontaneous pneumothorax should be primarily managed with minimal invasive strategies. In real-world clinical practice, oxygen supplementation regardless of the presence or absence of hypoxemia is frequently applied in patients with a pneumothorax, with the intention to enhance the resorption rate of air from the pleural cavity (\u201cnitrogen wash-out theory\u201d). This review provides an overview of the scientific origin of this practice in animal models, and its clinical use in adult and paediatric patients. Clinical studies from PubMed, Embase and Cochrane library were reviewed by the authors using the keywords, \u201coxygen AND pneumothorax\u201d, \u201cnitrogen washout AND pneumothorax\u201d and \u201cnitrogen AND pneumothorax\u201d, and recommendations from current guidelines were also reviewed by the authors. A selected total of nine clinical studies and three guidelines were included. Though in animal models there appears to be a therapeutic effect of oxygen therapy for the treatment of pneumothorax, clinical data in patient populations mainly stem from retrospective studies, mostly with a small sample size and inadequate study design. We recommend conducting prospective clinical studies with adequate methodology to address the question of whether or not oxygen therapy should be used to treat pneumothorax, regardless of the presence or absence of hypoxemia.<\/jats:p>","DOI":"10.3390\/jcm12134300","type":"journal-article","created":{"date-parts":[[2023,6,28]],"date-time":"2023-06-28T00:45:11Z","timestamp":1687913111000},"page":"4300","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["\u201cNitrogen Wash-Out\u201d in Non-Hypoxaemic Patients with Spontaneous Pneumothorax: A Narrative Review"],"prefix":"10.3390","volume":"12","author":[{"given":"Erwin","family":"Grasmuk-Siegl","sequence":"first","affiliation":[{"name":"Department of Respiratory and Critical Care Medicine, Klinik Floridsdorf, Br\u00fcnner Stra\u00dfe 68, 1210 Vienna, Austria"},{"name":"Karl-Landsteiner-Institute for Lung Research and Pulmonary Oncology, Health Care Group, Klinik Floridsdorf, Br\u00fcnner Stra\u00dfe 68, 1210 Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arschang","family":"Valipour","sequence":"additional","affiliation":[{"name":"Department of Respiratory and Critical Care Medicine, Klinik Floridsdorf, Br\u00fcnner Stra\u00dfe 68, 1210 Vienna, Austria"},{"name":"Karl-Landsteiner-Institute for Lung Research and Pulmonary Oncology, Health Care Group, Klinik Floridsdorf, Br\u00fcnner Stra\u00dfe 68, 1210 Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,6,27]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"653","DOI":"10.1136\/thoraxjnl-2014-206577","article-title":"Epidemiology of spontaneous pneumothorax: Gender-related differences","volume":"70","author":"Bobbio","year":"2015","journal-title":"Thorax"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"S12","DOI":"10.1055\/a-0588-4444","article-title":"Management of Spontaneous Pneumothorax and Postinterventional Pneumothorax: German S3-Guideline","volume":"143","author":"Schnell","year":"2018","journal-title":"Zent. Chir."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"321","DOI":"10.1183\/09031936.00219214","article-title":"ERS task force statement: Diagnosis and treatment of primary spontaneous pneumothorax","volume":"46","author":"Tschopp","year":"2015","journal-title":"Eur. Respir. J."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"ii18","DOI":"10.1136\/thx.2010.136986","article-title":"Management of spontaneous pneumothorax: British Thoracic Society Pleural Disease Guideline 2010","volume":"65","author":"MacDuff","year":"2010","journal-title":"Thorax"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1186\/s41073-019-0064-8","article-title":"SANRA-a scale for the quality assessment of narrative review articles","volume":"4","author":"Baethge","year":"2019","journal-title":"Res. Integr. Peer Rev."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"86","DOI":"10.1136\/bmj.4.5779.86","article-title":"Oxygen therapy for spontaneous pneumothorax","volume":"4","author":"Northfield","year":"1971","journal-title":"Br. Med. J."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1159\/000194541","article-title":"Noninvasive treatment of pneumothorax with oxygen inhalation","volume":"44","author":"Chadha","year":"1983","journal-title":"Respiration"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1136\/thx.35.1.37","article-title":"Prevention of pneumothorax in needle lung biopsy by breathing 100% oxygen","volume":"35","author":"Cormier","year":"1980","journal-title":"Thorax"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"825","DOI":"10.1016\/0003-4975(95)00007-8","article-title":"Resolution of experimental pneumothorax in rabbits by oxygen therapy","volume":"59","author":"Hill","year":"1995","journal-title":"Ann. Thorac. Surg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1097\/00005373-199808000-00020","article-title":"Resolution of experimental pneumothorax in rabbits by graded oxygen therapy","volume":"45","author":"England","year":"1998","journal-title":"J. Trauma."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"998","DOI":"10.1053\/jpsu.2000.6952","article-title":"Supplemental oxygen improves resolution of injury-induced pneumothorax","volume":"35","author":"Zierold","year":"2000","journal-title":"J. Pediatr. Surg."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Shaireen, H., Rabi, Y., Metcalfe, A., Kamaluddeen, M., Amin, H., Akierman, A., and Lodha, A. (2014). Impact of oxygen concentration on time to resolution of spontaneous pneumothorax in term infants: A population based cohort study. BMC Pediatr., 14.","DOI":"10.1186\/1471-2431-14-208"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"528","DOI":"10.1038\/jp.2014.55","article-title":"Administration of 100% oxygen does not hasten resolution of symptomatic spontaneous pneumothorax in neonates","volume":"34","author":"Clark","year":"2014","journal-title":"J. Perinatol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"5239","DOI":"10.21037\/jtd.2017.10.149","article-title":"Does oxygen therapy increase the resolution rate of primary spontaneous pneumothorax?","volume":"9","author":"Park","year":"2017","journal-title":"J. Thorac. Dis."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1001\/archinte.1932.00150080091006","article-title":"The absorption of gas from any closed space within the body: Particularly in the production of atelectasis and after pneumothorax","volume":"49","author":"Henderson","year":"1932","journal-title":"Arch. Intern. Med."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"635","DOI":"10.1016\/S0096-5588(20)32354-0","article-title":"Experimental observations on the effect of 95 per cent oxygen on the absorption of air from the body tissues","volume":"4","author":"Fine","year":"1935","journal-title":"J. Thorac. Surg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"375","DOI":"10.1097\/00000658-193603000-00006","article-title":"The treatment of gaseous distention of the intestine by the inhalation of ninety-five per cent oxygen","volume":"103","author":"Fine","year":"1936","journal-title":"Ann. Surg."},{"key":"ref_18","first-page":"1205","article-title":"Physiological equilibria of gas cavities in the body","volume":"Volume 4","author":"Fenn","year":"1965","journal-title":"Handbook of Physiology"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1038\/scientificamerican0266-56","article-title":"The lung","volume":"214","author":"Comroe","year":"1966","journal-title":"Sci. Am."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"178","DOI":"10.4077\/CJP.2012.BAA032","article-title":"Effects of high concentration oxygen treatment on traumatic pneumothorax in adult rabbits","volume":"55","author":"Shih","year":"2012","journal-title":"Chin. J. Physiol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1001\/jama.1954.03690190030009","article-title":"Spontaneous pneumothorax and its treatment","volume":"155","author":"Kircher","year":"1954","journal-title":"J. Am. Med. Assoc."},{"key":"ref_22","first-page":"499","article-title":"The management of spontaneous pneumothorax due to emphysematous blebs","volume":"120","author":"Hickok","year":"1965","journal-title":"Surg. Gynecol. Obs."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"606","DOI":"10.1152\/ajplegacy.1952.170.3.606","article-title":"Rate of gas absorption during atelectasis","volume":"170","author":"Dale","year":"1952","journal-title":"Am. J. Physiol."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Sperandeo, M., Maiello, E., Graziano, P., Simeone, A., De Cosmo, S., Dimitri, L., Di Micco, C., Perrone, E., Taurchini, M., and Ferretti, G. (2021). Effectiveness and Safety of Transthoracic Ultrasound in Guiding Percutaneous Needle Biopsy in the Lung and Comparison vs. CT Scan in Assessing Morphology of Subpleural Consolidations. Diagnostics, 11.","DOI":"10.3390\/diagnostics11091641"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1127","DOI":"10.2214\/ajr.165.5.7572489","article-title":"Quantification of pneumothorax size on chest radiographs using interpleural distances: Regression analysis based on volume measurements from helical CT","volume":"165","author":"Collins","year":"1995","journal-title":"AJR Am. J. Roentgenol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"780","DOI":"10.1136\/emj.2006.037143","article-title":"Estimating the rate of re-expansion of spontaneous pneumothorax by a formula derived from computed tomography volumetry studies","volume":"23","author":"Kelly","year":"2006","journal-title":"Emerg. Med. J."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"e12449","DOI":"10.1002\/emp2.12449","article-title":"An evidence-based review of primary spontaneous pneumothorax in the adolescent population","volume":"2","author":"Wilson","year":"2021","journal-title":"J. Am. Coll. Emerg. Physicians Open"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"305","DOI":"10.1186\/cc10229","article-title":"Supplementary oxygen for nonhypoxemic patients: O2 much of a good thing?","volume":"15","author":"Iscoe","year":"2011","journal-title":"Crit. Care"},{"key":"ref_29","first-page":"vi1","article-title":"BTS guideline for emergency oxygen use in adult patients","volume":"63","author":"Howard","year":"2008","journal-title":"Thorax"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"284","DOI":"10.1186\/s13054-015-0996-4","article-title":"van Bench-to-bedside review: The effects of hyperoxia during critical illness","volume":"19","author":"Helmerhorst","year":"2015","journal-title":"Crit. Care"},{"key":"ref_31","first-page":"853","article-title":"The effects of exposure to severe hyperoxemia on neurological outcome and mortality after cardiac arrest","volume":"88","author":"Astuto","year":"2022","journal-title":"Minerva Anestesiol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"2143","DOI":"10.1161\/CIRCULATIONAHA.114.014494","article-title":"Air Versus Oxygen in ST-Segment\u2013Elevation Myocardial Infarction","volume":"131","author":"Stub","year":"2015","journal-title":"Circulation"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1979","DOI":"10.1007\/s00134-006-0382-4","article-title":"Effect of inspired oxygen fraction on alveolar derecruitment in acute respiratory distress syndrome","volume":"32","author":"Aboab","year":"2006","journal-title":"Intensive Care Med."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"461","DOI":"10.1136\/pgmj.2007.056978","article-title":"Pneumothorax: An update","volume":"83","author":"Currie","year":"2007","journal-title":"Postgrad. Med. J."},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Nava, G.W., and Walker, S.P. (2022). Management of the Secondary Spontaneous Pneumothorax: Current Guidance, Controversies, and Recent Advances. J. Clin. Med., 11.","DOI":"10.3390\/jcm11051173"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/12\/13\/4300\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T20:01:35Z","timestamp":1760126495000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/12\/13\/4300"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,6,27]]},"references-count":35,"journal-issue":{"issue":"13","published-online":{"date-parts":[[2023,7]]}},"alternative-id":["jcm12134300"],"URL":"https:\/\/doi.org\/10.3390\/jcm12134300","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,6,27]]}}}