**5.2 Aspiration**

Patients with a first episode of primary spontaneous pneumothorax episode, which are hemodynamically stable and have a large pneumothorax (more than 2–3 centimeters of air in chest X-ray or more than 15% of the hemithorax) or those who have a progressive pneumothorax, or symptomatic with chest pain, or dyspnea should undergo needle aspiration [29, 42]. Several methods are used to perform simple aspiration, ranging from intravenous catheters in the second intercostal space in the midclavicular line with 16–18G cannula to chest tubes that can be removed once re-expansion of the lung is confirmed [43]. When the procedure is successful (less than 2 centimeters of air in the chest X-ray and improving in the breathing pattern), the patient can be discharged, with follow-up from 2 to 4 weeks. Simple aspiration is successful in 70% of the patients with moderate-sized primary pneumothorax; in patients older than 50 years or aspirations bigger than 2.5 liters, this method is likely to fail [38].
