What is the role of pleurodesis in the treatment of pneumothorax?

Updated: Apr 28, 2020
  • Author: Brian J Daley, MD, MBA, FACS, FCCP, CNSC; Chief Editor: Mary C Mancini, MD, PhD, MMM  more...
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Answer

In patients with repeated pneumothoraces who are not good candidates for surgery, pleurodesis (or sclerotherapy) may be necessary. Pleurodesis decreases the chance of pneumothorax recurrence and should be performed in consultation with the surgeon. This procedure should be performed just after reinflation of the lung if the presence of an air leak is not a contraindication. The 2 major sclerosing agents are talc and tetracycline derivatives (eg, minocycline, doxycycline).

Talc (5-10 g in 250 mL sterile isotonic sodium chloride solution) is usually insufflated during VATS or thoracotomy, but one study of 32 patients demonstrated findings of successful treatment with a chest tube (10% recurrence at 5 years).

In a large Department of Veterans Affairs study, tetracycline pleurodesis had a 25% recurrence in patients compared with 41% in control subjects. However, tetracycline no longer is available for pleurodesis because of stringent manufacturing requirements. Nonetheless, its derivatives minocycline and doxycycline have been shown to be successful sclerosing agents. Bleomycin was found to be ineffective in rabbits and is expensive.

Note that pleurodesis is painful, and the patient should be premedicated with benzodiazepine and intrapleural lidocaine (see Medication).


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