# Reply: Guideline recommendations don't exist in a vacuum

## TL;DR

The paper argues that clinical guidelines should only be changed when strong evidence is available, not based on assumptions.

## Contribution

It emphasizes the need for evidence-based updates to medical guidelines, specifically regarding pneumothorax treatment.

## Key findings

- Current evidence for thoracic suction in pneumothorax treatment is insufficient to support guideline changes.
- Recommendations should be based on solid evidence, not hypothetical risks.
- ERS guidelines remain unchanged due to lack of supporting data.

## Abstract

The letter “Debunking the myth: why wall suction should not be routine in pneumothorax treatment” postulated that negative pressure via thoracic suction may lead to worse outcomes for patients and suggests that the joint ERS/EACTS/ESTS clinical practice guidelines on adults with spontaneous pneumothorax [1] should be amended.

ERS guidelines must be evidence led. Until this evidence exists, recommendations cannot be made for or against an intervention, such as suction, where the relevant evidence base is very poor.
https://bit.ly/4dFXBDR