Article Text

Original article
Effectiveness of chemical pleurodesis in spontaneous pneumothorax recurrence prevention: a systematic review
  1. R J Hallifax1,
  2. A Yousuf1,
  3. H E Jones2,
  4. J P Corcoran1,
  5. I Psallidas1,
  6. N M Rahman1
  1. 1Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Trust, Oxford, UK
  2. 2Faculty of Health Sciences, School of Social and Community Medicine, University of Bristol, Bristol, UK
  1. Correspondence to Dr Rob J Hallifax, Oxford Respiratory Trials Unit, University of Oxford, Churchill Hospital, Oxford OX3 7LJ, UK; robhallifax{at}yahoo.com

Abstract

Objectives Spontaneous 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.

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 ORs (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 (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%.

Conclusions Chemical 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.

  • Pleural Disease
  • Thoracic Surgery

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/

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Footnotes

  • Twitter Follow Hayley Jones at @hayley0110

  • Contributors All authors included on a paper fulfil the criteria of authorship. RJH, AY, JPC, IP and NMR were involved in project conception, drafting and final approval of the manuscript. RJH and AY conducted abstract review and data analysis. HEJ reviewed methodology, analysis and presentation of the results. Elinor Harriss (Bodleian Health Care Libraries, University of Oxford) assisted with literature searches and article recovery. RJH is the guarantor.

  • Competing interests RJH is funded by a Clinical Training Fellowship from the Medical Research Council (MR/L017091/1).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The corresponding author (RH) holds the data analysis. No unpublished data exist.

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