Effectiveness of chemical pleurodesis in spontaneous pneumothorax recurrence prevention: A systematic review

Rob Hallifax, A Yousuf, Hayley Jones, JP Corcoran, I Psallidas, NM Rahman

Research output: Contribution to journalArticle (Academic Journal)peer-review

30 Citations (Scopus)
295 Downloads (Pure)

Abstract

Objectives:
Spontaneous Pneumothorax (SP) is a common pathology. International guidelines suggest pleurodesis for non-resolving air leak or recurrence prevention at second occurrence. This study comprehensively reviews the existing literature regarding chemical pleurodesis efficacy.
Design:
We systematically reviewed the literature to identify relevant randomised controlled trials (RCTs), case control studies and case series. We described the findings of these studies and tabulated relative recurrence rates or odds ratios (in studies with control groups). Meta-analysis was not performed due to substantial clinical heterogeneity.

Results:
Of 560 abstracts identified by our search strategy, 50 were included in our systematic review following screening. Recurrence rates in patients with chest tube drainage only were between 26.1% and 50.1%. Thoracoscopic talc poudrage (4 studies, (n=249) provided recurrence rates of between 2.5% and 10.2% with the only RCT suggesting an odds ratio of 0.10 compared to drainage alone. In
comparison, talc administration during Video Assisted Thoracic Surgery (VATS) from eight studies (n=2,324) recurrence was between 0.0% and 3.2% but the RCT did not demonstrate a significant difference compared to bleb/bullectomy alone. Minocycline appears similarly effective post-VATS (recurrence rates 0.0 to 2.9%). Prolonged air leak and recurrence prevention using tetracycline via chest drain (n=728) is likely to provide recurrence rates between 13.0% and 33.3% and autologous blood patch pleurodesis (n=270) between 15.6% and 18.2%.

Conclusion:
Chemical pleurodesis post-surgical treatment or via thoracoscopy appears to be most effective. Evidence for definitive success rates of each agent is limited by the small number of randomised trials or other comparative studies.
Original languageEnglish
Number of pages12
JournalThorax
Early online date1 Nov 2016
DOIs
Publication statusE-pub ahead of print - 1 Nov 2016

Keywords

  • Pneumothorax
  • pleurodesis
  • recurrence
  • talc
  • tetracycline

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