Pleurodesis: Which of which in management of recurrent primary spontaneous pneumothorax

Kasem, Ehab; Elhawary, Abeer

doi:10.1016/j.ejcdt.2015.12.010

Cited by 3 publications

(3 citation statements)

References 11 publications

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“…Out of 415 articles from literature research, 12 studies met the inclusion criteria. Five studies were removed based on our exclusion criteria, leaving one RCT and six OCSs for metaanalysis [11][12][13][14][15][16][17] (►Fig. 1).…”

Section: Study Characteristicsmentioning

confidence: 99%

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Mechanical versus Chemical Pleurodesis after Bullectomy for Primary Spontaneous Pneumothorax: A Systemic Review and Meta-Analysis

et al. 2019

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Introduction Primary spontaneous pneumothorax (PSP) and its high recurrence rate pose a therapeutic challenge to both patients and their managing surgeons. Mechanical or chemical pleurodesis can be used to prevent recurrence, but the optimal treatment often remains a matter of debate. This meta-analysis aims to compare the outcomes between mechanical and chemical pleurodesis following bullectomy for PSP. Materials and Methods Studies published up to 2019 were searched from Medline, Embase, Google Scholar, and Cochrane databases. A meta-analysis of randomized controlled trials (RCTs) and observational cohort studies (OCSs) comparing outcomes between mechanical and chemical pleurodesis for PSP was performed. Results Seven studies (one RCT and six OCSs) were included, comprising 1,032 cases of mechanical (799 abrasions, 202 pleurectomies, and 31 unspecified abrasions/pleurectomies/both), and 901 cases of chemical (643 talc, 69 minocycline, and 189 unspecified talc/kaolin) pleurodesis. The recurrence rate of pneumothorax after chemical pleurodesis (1.2%) was significantly lower than mechanical pleurodesis (4.0%) (pooled odds ratio [OR] = 3.00; 95% confidence interval [CI] = 1.59–5.67; p = 0.0007; I 2 = 19%). Hospital stay was also slightly shorter in the chemical pleurodesis group (pooled mean difference [MD] = 0.42 days; 95% CI = 0.12–0.72; p = 0.005; I 2 = 0%). There was no statistically significant difference in postoperative complications (pooled OR = 1.18; 95%CI = 0.40–3.48; p = 0.76; I 2 = 71%) and operative time (pooled MD = 3.50; 95%CI = − 7.28 to 14.28; p = 0.52; I 2 = 99%) between these two groups. Conclusion Chemical pleurodesis is superior to mechanical pleurodesis following bullectomy for PSP in reducing hospital stay and recurrence rate. However, more RCTs with longer follow-up are necessary to demonstrate the benefit of chemical pleurodesis for PSP.

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Section: Study Characteristicsmentioning

confidence: 99%

“…Four studies had analyzable data on complication rate. 13,14,16,17 A total of 1,072 patients were analyzed, with 583 patients receiving mechanical pleurodesis (544 pleural abrasions and 39 pleurectomies) and 489 receiving chemical pleurodesis (420 talc and 69 minocycline). There was no…”

Section: Complication Ratementioning

confidence: 99%

Mechanical versus Chemical Pleurodesis after Bullectomy for Primary Spontaneous Pneumothorax: A Systemic Review and Meta-Analysis

et al. 2019

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“…Apical parietal surgical pleurectomy and chemical pleurodesis are both acceptable treatments and appear to have comparable recurrence of pneumothorax. Summary of evidence 13 studies were eligible for inclusion: three randomised and 10 non-randomised [46,[51][52][53][54][55][56][57][58][59][60][61].…”

Section: Remarksmentioning

confidence: 99%

Joint ERS/EACTS/ESTS clinical practice guidelines on adults with spontaneous pneumothorax

Walker,

Hallifax,

Ricciardi

et al. 2024

Eur Respir J

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BackgroundThe optimal management for spontaneous pneumothorax (SP) remains contentious, with various proposed approaches. This joint clinical practice guideline from the ERS, EACTS and ESTS societies provides evidence-based recommendations for the management of SP.MethodsThis multidisciplinary Task Force addressed 12 key clinical questions on the management of pneumothorax, using ERS methodology for guideline development. Systematic searches were performed in MEDLINE and Embase. Evidence was synthesised by conducting meta-analyses, if possible, or narratively. Certainty of evidence was rated with GRADE (Grading of Recommendations, Assessment, Development and Evaluations). The Evidence to Decision framework was used to decide on the direction and strength of the recommendations.ResultsThe panel makes a conditional recommendation for conservative care of minimally symptomatic patients with primary spontaneous pneumothorax (PSP) who are clinically stable. We make a strong recommendation for needle aspiration over chest tube drain for initial PSP treatment. We make a conditional recommendation for ambulatory management for initial PSP treatment. We make a conditional recommendation for early surgical intervention for the initial treatment of PSP in patients who prioritise recurrence prevention. The panel makes a conditional recommendation for autologous blood patch in secondary SP patients with persistent air leak (PAL). The panel could not make recommendations for other interventions, including bronchial valves, suction, pleurodesis in addition to surgical resection or type of surgical pleurodesis.ConclusionsWith this international guideline, the ERS, EACTS and ESTS societies provide clinical practice recommendations for SP management. We highlight evidence gaps for the management of PAL and recurrence prevention, with research recommendations made.

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Joint ERS/EACTS/ESTS clinical practice guidelines on adults with spontaneous pneumothorax

Walker,

Hallifax,

Ricciardi

et al. 2024

European Journal of Cardio-Thoracic Surgery

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OBJECTIVES The optimal management for spontaneous pneumothorax (SP) remains contentious, with various proposed approaches. This joint clinical practice guideline from the ERS, EACTS and ESTS societies provides evidence-based recommendations for the management of SP. METHODS This multidisciplinary Task Force addressed 12 key clinical questions on the management of pneumothorax, using ERS methodology for guideline development. Systematic searches were performed in MEDLINE and Embase. Evidence was synthesised by conducting meta-analyses, if possible, or narratively. Certainty of evidence was rated with GRADE (Grading, Recommendation, Assessment, Development and Evaluation). The Evidence to Decision framework was used to decide on the direction and strength of the recommendations. RESULTS The panel makes a conditional recommendation for conservative care of minimally symptomatic patients with primary spontaneous pneumothorax (PSP) who are clinically stable. We make a strong recommendation for needle aspiration over chest tube drain for initial PSP treatment. We make a conditional recommendation for ambulatory management for initial PSP treatment. We make a conditional recommendation for early surgical intervention for the initial treatment of PSP in patients who prioritise recurrence prevention. The panel makes a conditional recommendation for autologous blood patch in secondary SP patients with persistent air leak (PAL). The panel could not make recommendations for other interventions, including bronchial valves, suction, pleurodesis in addition to surgical resection or type of surgical pleurodesis. CONCLUSIONS With this international guideline, the ERS, EACTS and ESTS societies provide clinical practice recommendations for SP management. We highlight evidence gaps for the management of PAL and recurrence prevention, with research recommendations made. Shareable Abstract This update of an ERS Task Force statement from 2015 provides a concise comprehensive update of the literature base. 24 evidence-based recommendations were made for management of pneumothorax, balancing clinical priorities and patient views.https://bit.ly/3TKGp9e

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Pleurodesis: Which of which in management of recurrent primary spontaneous pneumothorax

Cited by 3 publications

References 11 publications

Mechanical versus Chemical Pleurodesis after Bullectomy for Primary Spontaneous Pneumothorax: A Systemic Review and Meta-Analysis

Mechanical versus Chemical Pleurodesis after Bullectomy for Primary Spontaneous Pneumothorax: A Systemic Review and Meta-Analysis

Joint ERS/EACTS/ESTS clinical practice guidelines on adults with spontaneous pneumothorax

Joint ERS/EACTS/ESTS clinical practice guidelines on adults with spontaneous pneumothorax

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