Chest
Clinical InvestigationsSURGERYAn Audit of Medical Thoracoscopy and Talc Poudrage for Pneumothorax Prevention in 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.
References (36)
- et al.
Economic costs of spontaneous pneumothorax
Chest
(1991) - et al.
Management of spontaneous pneumothorax: an American College of Chest Physicians Delphi Consensus Statement
Chest
(2001) - et al.
Video-assisted thoracoscopic surgery versus thoracotomy for spontaneous pneumothorax
Ann Thorac Surg
(1994) Thoracoscopic evaluation and treatment of pulmonary disease
Surg Clin North Am
(2000)- et al.
Pneumothorax: experience with 1199 patients
Chest
(2000) - et al.
Thoracoscopic surgery as a routine procedure for spontaneous pneumothorax: results from 82 patients
Chest
(1995) - et al.
Secondary spontaneous pneumothorax
Ann Thorac Surg
(1993) - et al.
Talc pleurodesis for the treatment of pneumothorax and pleural effusion
Chest
(1994) - et al.
A comparison of thoracoscopic talc insufflation, slurry and mechanical abrasion pleurodesis
Chest
(1997) - et al.
Safety and efficacy of video-assisted thoracic surgical techniques for the treatment of spontaneous pneumothorax
J Thorac Cardiovasc Surg
(1995)
A limited axillary thoracotomy as primary treatment for recurrent spontaneous pneumothorax
Chest
Thoracoscopic wedge resection of blebs under local anesthesia with sedation for treatment of a spontaneous pneumothorax
Chest
Adult respiratory distress syndrome following intrapleural instillation of talc
J Thorac Cardiovasc Surg
Influence of particle size on extrapleural talc dissemination after talc slurry pleurodesis
Chest
Thoracoscopy: a prospective study of safety and outcome
Chest
Video-assisted thoracic surgery in the elderly: a review of 307 cases
Chest
Incidence of spontaneous pneumothorax in Olmsted County, Minnesota: 1950–1974
Am Rev Respir Dis
Pneumothorax, chylothorax, hemothorax and fibrothorax
Cited by (56)
Pleural Interventions—Thoracoscopy
2021, Encyclopedia of Respiratory Medicine, Second EditionPleurodesis
2021, Encyclopedia of Respiratory Medicine, Second EditionMedical Pleuroscopy
2013, Clinics in Chest MedicineCitation Excerpt :Tschopp and colleagues70 randomized 108 such patients to either thoracoscopy and poudrage, or chest drain and talc slurry, and were able to show a significantly reduced rate of recurrence at 5 years (5% vs 34%) in the thoracoscopy arm, suggesting this approach certainly has merit. Similar efficacy for poudrage at thoracoscopy has been demonstrated in patients with secondary pneumothoraces due to chronic obstructive pulmonary disease, albeit in a less robust manner,71 with this group of patients potentially being of particular interest to medical thoracoscopy because they are more likely to be unfit for VATS interventions. It is universally agreed on that complicated pleural space infection or empyema requires drainage, unless a late-stage fibrothorax has developed, in which case thoracic surgery is required.
Pleuroscopy in 2013
2013, Clinics in Chest MedicineCitation Excerpt :These patients are at higher risk of general anesthesia, VATS, and thoracotomy, but require interventions to prevent SP recurrence. In these patients, pleuroscopic talc poudrage performed under local anesthesia and conscious sedation has been shown to be an effective therapeutic option.17,56 In recurrent primary SP, VATS with staple bullectomy and parietal pleural abrasion, pleurectomy, or talc poudrage is preferred.57
Pleura disease
2011, Revue des Maladies Respiratoires Actualites