Chest
Volume 125, Issue 4, April 2004, Pages 1315-1320
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Clinical Investigations
SURGERY
An Audit of Medical Thoracoscopy and Talc Poudrage for Pneumothorax Prevention in Advanced COPD

https://doi.org/10.1378/chest.125.4.1315Get rights and content

Objectives

To prospectively study all patients with COPD and spontaneous pneumothorax (SP) who underwent thoracoscopic talc poudrage (TP) under local anesthesia to determine its efficacy and safety in recurrence prevention.

Methods

Data on clinical measurements, complications, duration of chest tube drainage, length of hospital stay, and outcome were collected.

Results

Forty-one patients (38 men and 3 women) with a mean (± SD) age of 70.7 ± 7.2 years were treated. All patients had COPD, with a mean FEV1 of 41 ± 14% predicted. The majority of SPs measured 20 to 50% in size, and 34% were recurrent. Three grams of talc were insufflated into the pleural cavity without complications. Thirteen patients (32%) complained of pain, 5 (12%) developed fever, 27 (66%) had subcutaneous emphysema, and 7 (17%) had prolonged air leaks. Postoperative chest tube drainage and hospital stay were 4 and 5 days, respectively. Success was 95% after a median follow-up of 35 months. Four patients with FEV1 of < 40% predicted died within 30 days of the procedure, yielding a mortality rate of 10%. FEV1 (in liters), FEV1 (in % predicted), and ischemic heart disease were risk factors that influenced early mortality.

Conclusion

Thoracoscopic TP is effective for pneumothorax prevention and can be performed with acceptable mortality in patients with advanced COPD.

Section snippets

Patients

Included in this study were all patients with moderate-to-severe COPD and SP who underwent MT-TP from November 1997 to December 2001. The classification of SPs into < 20%, 20 to 50%, and > 50% was based on the average interpleural distance obtained from frontal and lateral chest radiograph (CXR),12 while COPD severity was derived from values of postbronchodilator FEV1 (in liters), FEV1 (% predicted), and FEV1/ FVC ratio (%) within a year prior to MT-TP. Moderate COPD was defined as an FEV1/ FVC

RESULTS

Forty-one patients with SP underwent MT-TP and were prospectively observed for 35 months (range, 18.5 to 47 months). The mean (± SD) age was 70.7 ± 7.2 years, and there were 38 men and 3 women. All patients cited a significant mean smoking history of 52.8 ± 22.3 pack-years, 24 patients (59%) had experienced a previous tuberculosis infection, and 12 patients (29%) had ischemic heart disease (IHD). Thirty patients (73%) had moderate COPD, while the remaining 11 patients (27%) had severe COPD.

Discussion

COPD is a major public health problem worldwide15 and is a leading cause of mortality, with deaths occurring as result of acute respiratory failure, pneumothorax, pneumonia, pulmonary embolism, and cardiac arrhythmias.16 The goals of SP management in patients with underlying COPD should not only include drainage of intrapleural air to facilitate the reexpansion of lung and pleural healing, but, more importantly, attempts at permanent pleurodesis must be considered. Although in recent years VATS

ACKNOWLEDGMENT

The authors would like to acknowledge Arul Earnest for his invaluable statistical input, and Monica Tang for her dedication in data collection.

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