How is recurrent pneumothorax prevented?

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

Strategies for the prevention of recurrent pneumothorax include observation, surgical and nonsurgical pleurodesis, and bleb resection. Other important points to keep in mind include the following:

  • Prompt recognition and treatment of bronchopulmonary infections decreases the risk of progression to a pneumothorax
  • When subclavian vein cannulation is required, use the supraclavicular approach rather than the infraclavicular approach when possible to help decrease the likelihood of pneumothorax formation
  • The incidence of iatrogenic tension pneumothorax may be decreased with prophylactic insertion of a chest tube in patients with a simple pneumothorax that requires positive pressure ventilation
  • Pleurodesis decreases the risk of recurrence of spontaneous pneumothorax, as does thoracotomy or VATS to excise the bullae

A study by Chen et al found that pleural abrasion with minocycline pleurodesis was as effective as apical pleurectomy for patients with PSP with high recurrence risk. Patients undergoing both procedures had similar durations of postoperative chest drainage, lengths of hospital stay, complication rates, long-term residual chest pain, and long-term pulmonary function. The rate of recurrence was 3.8% for both procedures. [71]

An Italian study reported on a new fibrin sealant that has proven to be a safe and effective tool for preventing alveolar air leaks after lung resections. The sealant also reportedly shortens the duration of postoperative alveolar air leaks. [72]


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