Chemical pleurodesis for spontaneous pneumothorax

Abstract

Pneumothorax is defined as the presence of air in the pleural cavity. Spontaneous pneumothorax, occurring without antecedent traumatic or iatrogenic cause, is sub-divided into primary and secondary. The severity of pneumothorax could be varied from asymptomatic to hemodynamically compromised. Optimal management of this benign disease has been a matter of debate. In addition to evacuating air from the pleural space by simple aspiration or chest tube drainage, the management of spontaneous pneumothorax also focused on ceasing air leakage and preventing recurrences by surgical intervention or chemical pleurodesis. Chemical pleurodesis is a procedure to achieve symphysis between the two layers of pleura by sclerosing agents. In the current practice guidelines, chemical pleurodesis is reserved for patients unable or unwilling to receive surgery. Recent researches have found that chemical pleurodesis is also safe and effective in preventing pneumothorax recurrence in patients with the first episode of spontaneous pneumothorax or after thoracoscopic surgery and treating persistent air leakage after thoracoscopic surgery. In this article we aimed at exploring the role of chemical pleurodesis for spontaneous pneumothorax, including ceasing air leakage and preventing recurrence. The indications, choice of sclerosants, safety, effects, and possible side effects or complications of chemical pleurodesis are also reviewed here.

ERS task force statement: diagnosis and treatment of primary spontaneous pneumothorax

“…The recurrence rate seen after talc poudrage is comparable to that seen after mechanical pleurodesis [143][144][145]. Other sclerosing agents given via a chest tube have been used for prevention of pneumothorax, and include bleomycin dextrose, glucose 50%, iodine, tetracycline or talc slurry [146]. Tetracycline has also been used but is less efficacious than talc poudrage [116,147] and is no longer available in many countries [148].…”

Experience of Pleurodesis with a 50% Glucose Solution in Patients with Secondary Pneumothorax: A Case Series

“…Instillation of chemical agents, doxycycline, and talc has been recommended in cases of prolonged air leakage. [3] Pleurodesis is an easy, safe, effective, and well-tolerated treatment for secondary pneumothorax [6,7,9,11] Some studies have reported the effectiveness of pleurodesis using a 50% glucose solution in treating pneumothorax with prolonged air leakage after a surgical procedure or chylothorax [12,14,15]. To my knowledge, only a few studies have investigated patients with secondary pneumothorax in whom surgery is contraindicated [13].…”

“…The main complications of conventional pleurodesis, such as pain and fever, [8,9] Present cases were obtained once with the use of a glucose solution, but it was unnecessary analgesics. In fact, the patient in Case 1 rejected to use OK-432 because of prior its side effects, despite it was effective.…”

“…Pleurodesis for malignant pleurisy and pneumothorax with prolonged air leakage is simple, effective, and safe [6][7][8][9][10]. OK-432, autoblood, and minocycline are often used in pleurodesis for refractory pneumothorax [6,7,9,11].…”

“…OK-432, autoblood, and minocycline are often used in pleurodesis for refractory pneumothorax [6,7,9,11].…”