Treatment of Pneumothorax Immediate needle decompression for tension pneumothoraces Observation and follow-up x-ray for small, asymptomatic, primary spontaneous pneumothoraces Catheter aspiration for large or symptomatic primary spontaneous pneumothoraces Tube thoracostomy for secondary and traumatic pneumothoraces Patients should receive supplemental oxygen until chest x-ray results are available because oxygen accelerates pleural reabsorption of air.