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

Abstract

ObjectivesSpontaneous pneumothorax 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.DesignWe 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 ORs (in studies with control groups). Meta-analysis was not performed due to substantial clinical heterogeneity.ResultsOf 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 (four studies (n=249)) provided recurrence rates of between 2.5% and 10.2% with the only RCT suggesting an OR of 0.10 compared with drainage alone. In comparison, talc administration during video-assisted thoracic surgery (VATS) from eight studies (n=2324) recurrence was between 0.0% and 3.2%, but the RCT did not demonstrate a significant difference compared with bleb/bullectomy alone. Minocycline appears similarly effective post-VATS (recurrence rates 0.0–2.9%). Prolonged air leak and recurrence prevention using tetracycline via chest drain (n=726) 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%.ConclusionsChemical pleurodesis postsurgical 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.

Spontaneous pneumothorax in diffuse cystic lung diseases

“…Successful use of TPC has also been reported in PLCH, BHD, bronchiolitis obliterans, and Ehlers-Danlos Syndrome (97, 98). Blood patch pleurodesis, whereby a patients own blood is instilled through an existing chest tube, has emerged as an effective option for treatment for pneumothorax with reported pneumothorax recurrence rates of 15.6–18.2% (99). The advantage of this technique is the almost complete absence of typical pleurodesis-associated side effects such as pain and fever (100).…”

Does sericin pleurodesis increase the basic fibroblastic growth factor and high-sensitive c-reactive protein levels in rat plasma?

“…Talcum powder is the most commonly used agent worldwide in inducing pleurodesis, and is considered to have the highest efficiency [20,21]. In a study by Yazicioglu et al comparing sericin with other pleurodesis agents, sericin pleurodesis was found to be superior in certain aspects when compared to talcum powder [4].…”

Pneumothorax management: time to improve the evidence base

“…In Thorax , Halifax RJ,  et al 10 try to answer one of these questions. They undertook a systematic review of the effectiveness of chemical pleurodesis in spontaneous pneumothorax recurrence prevention.…”