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Chest. 2004 Apr;125(4):1315-20.

An Audit of medical thoracoscopy and talc poudrage for pneumothorax prevention in advanced COPD.

Author information

1
Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore. gm3lp@sgh.com.sg

Abstract

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 FEV(1) 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 FEV(1) of < 40% predicted died within 30 days of the procedure, yielding a mortality rate of 10%. FEV(1) (in liters), FEV(1) (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.

PMID:
15078740
DOI:
10.1378/chest.125.4.1315
[Indexed for MEDLINE]

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