Minocycline and Talc Slurry Pleurodesis for Patients with Secondary Spontaneous Pneumothorax

Minocycline and talc slurry pleurodesis for patients with secondary spontaneous pneumothorax

C. K. Ng,* F. W. Ko,† J. W. Chan,* A. Yeung,‡ W. K. S. Yee,§ L. K. Y. So,¶ B. Lam,# M. M. L. Wong,** K. L. Choo,†† A. S. S. Ho,‡‡ P. Y. Tse,§§ S. L. Fung,¶¶ C. K. Lo,## W. C. Yu*** * Department of Medicine, Queen Elizabeth Hospital, Hong Kong, † Department of Medicine and Therapeutics, Prince of Wales Hospital, Hong Kong, ‡ Department of Medicine, Ruttonjee and Tang Shiu Kin Hospital, Hong Kong, § Department of Medicine, Kwong Wah Hospital, Hong Kong, ¶ Department of Medicine, Pamela Youde Nethersole Eastern Hospital, Hong Kong, # Department of Medicine, Queen Mary Hospital, Hong Kong, ** Department of Medicine, Caritas Medical Centre, Hong Kong, †† Department of Medicine, North District Hospital, Hong Kong, ‡‡ Department of Medicine, Alice Ho Miu Ling Nethersole Hospital, Hong Kong, §§ Department of Medicine, Tseung Kwan O Hospital, Hong Kong, ¶¶ Respiratory Medical Department, Grantham Hospital, Hong Kong, ## Department of Cardiothoracic Surgery, Queen Elizabeth Hospital, Hong Kong, *** Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong, Hong Kong SAR, China

SUMMARY

SETTING: Few studies have evaluated the sclerosing ef- pleurodesis were independently associated with proce- fi cacy of minocycline, and none have specifi cally com- dural failure. Pain was experienced in respectively 44.6% pared its sclerosing effi cacy and safety profi les with talc and 37.5% of the minocycline and the talc slurry groups. slurry in secondary spontaneous pneumothorax (SSP). Pain was more common in patients receiving high doses DESIGN: A retrospective analysis was conducted in pa- of talc (⩾5 g; P = 0.03). Respiratory distress was found tients with SSP who underwent chemical pleurodesis in respectively 1.7% and 1.6% of the minocycline and from January to December 2004 with minocycline or talc slurry groups. talc slurry in 12 public hospitals of Hong Kong. CONCLUSION: Minocycline and talc slurry had compa- RESULT: There were 121 episodes of minocycline pleu- rable sclerosing effi cacy in SSP, with immediate success rodesis and 64 episodes of talc slurry pleurodesis. Im- rates of >70%. Pain was the most common adverse ef- mediate procedural failure were similar in the mino- fect and respiratory distress was uncommon. Both ap- cycline and talc slurry groups (21.5% vs. 28.1%, P = peared to be effective and safe for chemical pleurodesis 0.31). Presence of interstitial lung disease, ⩾2 previous in SSP. episodes of pneumothorax, requiring mechanical venti- KEY WORDS: minocycline; talc slurry; secondary spon- lation during pleurodesis and persistent air leak before taneous pneumothorax; pleurodesis; adverse effects

PREVENTION OF RECURRENCE is important in lished data on its effi cacy in the prevention of pneu- patients with secondary spontaneous pneumothorax mothorax in comparison to other agents. (SSP), as many of them have poor respiratory reserves, The sclerosing effi cacy of tetracycline in pneumo- and high mortality rates have been reported with re- thorax is around 45–77%.12–14 As tetracycline was no currences.1,2 Without pleurodesis, the recurrence rate longer available,15 its derivatives, such as oxytetracy- in SSP was around 40–80%.1,3,4 The British Thoracic cline, doxycylcine and minocycline had been used in- Society (BTS) and the American College of Chest Phy- stead. Minocycline and tetracycline had comparable sicians (ACCP) advocated pleurodesis in the fi rst oc- sclerosing effi cacies in animal studies.16 The scleros- currence of SSP.5,6 Open thoracotomy with surgical ing effi cacy of minocycline in primary spontaneous pleurectomy remains the gold standard, but the tho- pneumothorax (PSP) has been evaluated by Chen et racoscopic approach has comparable success rates.7 al.17,18 Apart from a case report19 and a study that Chemical pleurodesis is an alternative when surgical contained a mixture of patients with PSP and SSP,20 pleurodesis is contraindicated.5,6 Thoracoscopic talc no human study had specifi cally addressed the scleros- poudrage has reported success rates of >90%,8,9 al- ing effi cacy of minocycline in the prevention of SSP. though that is not widely practised or readily avail- The primary aim of the present study was to com- able. The effi cacy of talc slurry in the prevention of pare the immediate sclerosing effi cacy21 of intra- SSP recurrence in humans was not well explored, and pleural minocycline and talc slurry in the preven- small-scale studies in the 1980s revealed its scleros- tion of SSP recurrence. Secondary aims included the ing effi cacy to be 93–100%.10,11 There were no pub- evaluation of 1) factors that were associated with

Correspondence to: C K Ng, Department of Medicine, Queen Elizabeth Hospital, Hong Kong, 30 Gascoigne Road, Kow- loon, Hong Kong, China. Tel: (+852) 2958 2349. Fax: (+852) 2215 1211. e-mail: [email protected] Article submitted 18 January 2010. Final version accepted 7 April 2010. Talc slurry and minocycline for pleurodesis 1343 im mediate procedural failure and 2) the adverse ef- Table 1 Clinical characteristics of patients who underwent fects and safety profi les of these two agents in chem- chemical pleurodesis ical pleurodesis. Minocycline Talc slurry (n = 121) (n = 64) n (%) n (%) P value STUDY POPULATION AND METHODS Sex, male 114 (94.2) 59 (92.2) 0.60 Study design and patient selection Age, years, median [IQR] 73 [66–77] 71 [63–75] 0.19 Ever smokers 114 (94.2) 58 (90.6) 0.36 This is a multicentre retrospective study that involved Chronic obstructive pulmonary 10 public hospitals and two university-affi liated hos- disease 95 (78.4) 40 (62.5) 0.02* Old tuberculosis 43 (35.5) 27 (42.2) 0.38 pitals in Hong Kong. The hospital records of patients Interstitial lung diseases 4 (3.3) 4 (6.3) 0.35 admitted from January to December 2004 and with Previous history of pneumothorax 43 (35.5) 22 (34.4) 0.88 discharge diagnoses of spontaneous pneumothorax ⩾2 previous episodes of pneumothorax 16 (13.2) 9 (14.1) 0.87 were retrieved and studied by the investigators. Pa- Persistent leakage before tients were included if they had SSP and subsequently pleurodesis 31 (25.6) 21 (32.8) 0.30 underwent chemical pleurodesis with either minocy- Large pneumothorax (⩾2 cm) 75 (62.0) 48 (75.0) 0.07 Required >1 intercostal tubes 17 (14.4) 12 (18.8) 0.40 cline (300 mg in 100 ml 9% normal saline) or talc Required suction in the slurry (2.5–5.0 g talc in suspension with 100 ml 9% management of pneumothorax 57 (47.1) 42 (65.6) 0.02* normal saline) via the intercostal tubes in the same Put on ventilatory support 5 (4.1) 3 (4.7) 1.00 admission. Patients were excluded from the study if * P < 0.05. 1) their age was <18 years, 2) the diagnosis was not IQR = interquartile range. SSP, 3) hospital records could not be retrieved and 4) they underwent surgical pleurodesis or chemical tive pulmonary disease and required suction during pleurodesis with other agents. pneumothorax drainage in the minocycline and talc slurry groups, respectively (Table 1). Data collection Although the median length of hospitalisation was Information collected included demographic data, longer in the talc slurry group, other outcomes, such characteristics of pneumothoraces, dosages and side as immediate failure rates, subsequent need for re- effects of sclerosants, result of pleurodesis and pre- peated chemical or surgical pleurodesis and median defi ned clinical outcomes. ‘Large’ pneumothorax was duration of chest drainage, were not signifi cantly dif- defi ned as one with distance of visceral pleura to chest ferent between the two groups (Table 2). wall of ⩾2 cm.6 Immediate failure was defi ned as Multivariate analysis revealed that having under- having recurrence of pneumothorax within the same lying interstitial lung disease, history of ⩾2 previous hospitalisation after the pleurodesis.21 Approvals from episodes of pneumothorax, having mechanical venti- the Institutional Review Boards (IRB) or Hospital lation during pleurodesis and having persistent air Ethics Committees of all the participating hospitals leakage before pleurodesis were independently asso- were obtained before the study. ciated with failure of chemical pleurodesis in SSP. The choice of chemical sclerosants (talc or minocycline) Statistical analysis was not independently associated with immediate Results were expressed in median (interquartile range) procedural failure (adjusted odds ratio [aOR] 0.98, for continuous variables, or number (percentages) for 95%CI 0.44–2.22, P = 0.97; Table 3). categorical data. Student’s t-test or Mann-Whitney The frequency of pain was not signifi cantly differ- U test were used to compare the differences between ent between the two groups (Table 4). Pain was expe- continuous variables, while Pearson’s χ2 test was used rienced in 20 patients (47.6%) who received ⩾5 g to compare categorical data. Logistic regression was used to determine the independent predictors of clini- Table 2 Clinical outcomes in the minocycline and talc cal outcomes. All statistical tests of signifi cance were slurry group* two-sided, unless otherwise stated. A P of ⩽0.05 was Minocycline Talc slurry considered as statistically signifi cant. Statistical anal- (n = 121) (n = 64) ysis was performed using SPSS, Version 11.0 (Statisti- n (%) n (%) P value cal Package for the Social Sciences, Chicago, IL, USA). Immediate procedural failure 26 (21.5) 18 (28.1) 0.31 Failure and underwent repeated medical pleurodesis 22 (18.2) 16 (25.0) 0.28 RESULTS Failure and underwent surgical pleurodesis 1 (0.8) 1 (1.6) 1.00 There were 483 episodes of SSP and 215 episodes of Duration on chest drain after subsequent chemical pleurodesis. Minocycline and pleurodesis, median days [IQR] 2 [1.0–7.0] 3 [1.0–5.0] 0.65 Length of hospital stay, talc slurry was employed in respectively 121 (56.3%) median days [IQR] 15 [8–28] 20 [13–33] 0.02† and 64 episodes (29.8%). The clinical characteristics * No death related to pleurodesis recorded. of the two groups of patients were largely compara- † P < 0.05. ble, except that more patients had chronic obstruc- IQR = interquartile range. 1344 The International Journal of Tuberculosis and Lung Disease

Table 3 Predictors of pleurodesis failure

Successful Failed pleurodesis pleurodesis Crude Adjusted (n = 141) (n = 44) odds ratio odds ratio n (%) n (%) (95%CI) (95%CI) P value Male sex 132 (93.6) 41 (93.2) 1.07 (0.28–4.15) 0.87 (0.18–4.18) 0.87 Age > 60 years 117 (83.0) 38 (86.4) 1.30 (0.49–3.42) 0.78 (0.23–2.65) 0.69 Smoker 130 (92.2) 42 (95.5) 1.78 (0.38–8.34) 2.92 (0.44–19.13) 0.27 Chronic obstructive pulmonary disease 103 (73.0) 32 (72.7) 0.98 (0.46–2.11) 1.46 (0.51–4.18) 0.48 Old tuberculosis 52 (36.9) 18 (40.9) 1.19 (0.59–2.37) 1.46 (0.62–3.41) 0.39 Interstitial lung diseases 4 (2.8) 4 (9.1) 3.43 (0.82–14.31) 9.41 (1.61–54.95) 0.01* ⩾2 previous episodes of pneumothorax 16 (11.3) 9 (20.5) 2.01 (0.82–4.93) 3.40 (1.17–9.89) 0.03* Large pneumothorax 93 (66.0) 30 (68.2) 1.11 (0.54–2.28) 1.89 (0.78–4.55) 0.16 On mechanical ventilation 4 (2.8) 4 (9.1) 3.43 (0.82–14.31) 5.76 (1.05–31.55) 0.04* Persistent air leak before pleurodesis 29 (20.6) 23 (52.3) 4.23 (2.06–8.68) 6.20 (2.57–14.94) <0.001† Put on suction 68 (48.2) 31 (70.5) 2.56 (1.24–5.30) 2.05 (0.87–4.80) 0.10 Use of minocycline compared to talc as the sclerosant 46 (32.6) 18 (40.9) 1.43 (0.71–2.87) 0.98 (0.44–2.22) 0.97

* P < 0.05. † P < 0.001. talc in comparison to four patients (18.2%) who re- tion onto the mesothelial surface because talc parti- ceived <5 g talc (P = 0.03). The frequencies of other cles would sediment into the dependent parts of the side effects, including fever, nausea, vomiting and re- pleural cavity.14 Moreover, it was impossible to en- spiratory distress, were also not signifi cantly different sure the uniform distribution of talc slurry onto pleu- between the two groups (Table 4). Acute respiratory ral surfaces without direct visualisation through tho- distress syndrome (ARDS), empyema thoracis and racoscopy. This might explain its inferiority when death related to pleurodesis were not noted. compared to talc poudrage. Furthermore, the dose of talc slurry administered in our study was not standardised, as it ranged from 2.5 to 5.0 g, similar to DISCUSSION recommendations from international guidelines.6 To the best of our knowledge, this is the fi rst study to However, no dose-response relationship between talc specifi cally compare the sclerosing effi cacies and safety and success of pleurodesis has been established.6 profi les of intra-pleural minocycline against talc slurry No study has specifi cally addressed the sclerosing in patients with SSP. As talc slurry and minocycline are effi cacy of minocycline in patients with SSP. Mino- commonly employed sclerosants, such information cycline was less effi cacious than talc slurry in an ani- will be useful for clinicians in making their choices. mal study.22 The Veterans Administration Cooperative The sclerosing effectiveness of talc slurry described study, with 80% of its subjects being SSP, showed in the literature was 93–100%.10,11 In our study, the that the 30-day recurrence rate with tetracycline pleu- immediate success rates of talc slurry were compa- rodesis was 19%,13 which was comparable to our rable to those of minocycline, and both were under 21.5% recurrence rate within the same hospitalisa- 80%. It is diffi cult to precisely control the dosage of tion. This implied that the immediate success rate of talc slurry delivered to pleural surfaces. The water minocycline was similar to that of talc slurry and solubility of talc is poor and most of it would remain tetracycline.13 in suspension form.14 A proportion of talc slurry Few studies addressed the predictors of pleuro- might stick onto the wall of the intercostal tube while desis failure in SSP. Our logistic regression showed it was instilled in the pleural cavity. Rotating patients that having interstitial lung diseases, ⩾2 episodes of at different positions did not improve the distribu- pneumothorax in the past, persistent air leak before pleurodesis and receiving mechanical ventilation during pleurodesis were independently associated with Table 4 Side effects associated with minocycline and talc slurry pleurodesis failure. Failure of pleura apposition and symphysis might be encountered in patients having Minocycline Talc slurry persistent air-leaks and in patients under mechanical (n = 121) (n = 64) n (%) n (%) P value ventilation, where the positive intra-pleural pressure might hinder the closure of pleura-pulmonary fi stu- Any pain experienced 54 (44.6) 24 (37.5) 0.35 Mild to moderate pain, requiring las. Patients with multiple previous pneumothoraces non-opioid analgesics 27 (22.3) 14 (21.9) 0.95 might also have more pleural adhesions related to Moderate to severe pain, requiring previous pleural manipulations,23 such as tube in- opioid analgesics 27 (22.3) 10 (15.6) 0.28 Fever 5 (4.1) 1 (1.6) 0.67 sertions and aspirations. Thoracoscopic studies have Nausea or vomiting 0 1 (1.6) 0.35 demonstrated that adhesions can prevent the uniform Respiratory distress with new coating of talc onto pleural surfaces, thereby reduc- radiological inﬁ ltrates 2 (1.7) 1 (1.6) 1.00 ing its sclerosing effectiveness.24 Talc slurry and minocycline for pleurodesis 1345

Although the median duration of hospitalisation remains unclear since the timing of recurrence might was longer in the talc slurry group, the duration of depend on factors such as the severity of the under- intercostal tube drainage after pleurodesis was similar lying pleural and pulmonary pathologies and the scle- in the two groups. The prolonged hospitalisation may rosing agent employed. therefore be accounted for by other clinical or social problems. CONCLUSION Pain was the most common side effect with minocycline pleurodesis.25 The literature reported that Intra-pleural minocycline was as effective and safe as 58.2% of patients with tetracycline pleurodesis suf- talc slurry in preventing pneumothorax recurrence in fered from pain, which was attributed to the induced SSP in the same hospitalisation. Pain was a common pleural infl ammation.26,27 Pain might correlate with adverse effect with both methods, although the pain the success of tetracycline pleurodesis, and was re- in talc might be dose-related. Severe adverse reactions duced by the diluting effect of local anaesthesia such such as respiratory distress were uncommon in both. as lignocaine.13 Pain was less frequently reported with talc pleurodesis.14 In this study, the prevalence of se- Acknowledgements vere pain in the talc slurry group (15.6%) was higher The authors thank the following people for their assistance and than the 7% incidence reported in the literature.8,27 support in the study: M Lit (Queen Elizabeth Hospital), D Hui and The difference might be related to individuals’ varia- K Lai (Prince of Wales Hospital), D Chui (Caritas Medical Centre), H Kwok and C W Lam (Ruttonjee Hospital), Y-P Lam (Pamela tions in pain perceptions and the dose of talc slurry Youde Nethersole Eastern Hospital), W-K Lam, C-M Wong, C-W applied. In this study, patients who received ⩾5 g talc Yu and H-Y Kwan (North District Hospital), C Poon, J Kwok and slurry experienced more pain than those who re- C Yui (Princess Margaret Hospital). The authors also thank the ceived <5 g. The optimal dose of talc slurry was not Scientifi c Sub-Committee of the Hong Kong Thoracic Society for well addressed,6 and 2–10 g of talc slurry had been its directive and advisory role in conducting this territory-wide research. applied in previous studies involving SSP patients.10,11 As the pleural surfaces in pneumothorax are rela- tively normal in comparison to those in malignant References conditions, a lower dose of talc powder may suffi ce. 1 Videm V, Pillgram-Larsen J, Ellingsen O, Andersen G, Ovrum The incidence of ARDS was estimated to be 1–9% E. Spontaneous pneumothorax in chronic obstructive pulmo- in the literature25 and was believed to be related to nary disease: complications, treatment and recurrences. Eur J the particle size of talc.26,27 ‘Mixed talc’ was shown Respir Dis 1987; 71: 365–371. 2 Tschopp J M, Rami-Porta R, Noppen M, Astoul P. Manage- to produce more lung and systemic infl ammation ment of spontaneous pneumothorax: state of the art. Eur than ‘graded talc’ with particle size <10 μm.26 At the Respir J 2006; 28: 637–650. time of the study, only ‘mixed talc’ was used in Hong 3 Lippert H L, Lund O, Blegvad S, Larsen H V. Independent risk Kong and the incidence of respiratory distress after factors for cumulative recurrence rate after fi rst spontaneous talc pleurodesis was comparable to overseas reports.27 pneumothorax. Eur Respir J 1991; 4: 324–331. 4 Baumann M H, Noppen M. Pneumothorax. Respirology 2004; However, a defi nite association of respiratory distress 9: 157–164. with the use of talc slurry could not be reliably estab- 5 Baumann M H, Strange C, Heffner J E, et al. Management of lished by reviewing hospital records alone. Empyema spontaneous pneumothorax: an American College of Chest Phy- was not found and should not be expected if sterilised sicians Delphi consensus statement. Chest 2001; 119: 590–602. talc was used.27 No death related to pleurodesis was 6 Henry M, Arnold T, Harvey J. BTS guidelines for the management of spontaneous pneumothorax. Thorax 2003; 58 (Suppl reported, which, together with the absence of other se- 2): iiS39–S52. rious side effects such as ARDS, suggested that both 7 Barker A, Maratos E C, Edmonds L, Lim E. Recurrence rates agents were safe chemical sclerosants. of video-assisted thoracoscopic versus open surgery in the pre- The study was limited by its retrospective nature. vention of recurrent pneumothoraces: a systematic review of It would be diffi cult to validate the accuracy of data randomised and non-randomised trials. Lancet 2007; 370: retrieved from hospital notes. As discussed above, the 329–335. 8 Kennedy L, Sahn S A. Talc pleurodesis for the treatment of dose of talc applied in our study was not standardised pneumothorax and pleural effusion. Chest 1994; 106: 1215– and might possibly confound the observation of its 1222. effi cacy. The long-term pneumothorax recurrence rates 9 Gyorik S, Erni S, Studler U, Hodek-Wuerz R, Tamm M, were not explored and we could not explore the pos- Chhajed P N. Long-term follow-up of thoracoscopic talc pleu- sible associations between short-term and longer-term rodesis for primary spontaneous pneumothorax. Eur Respir J 2007; 29: 757–760. recurrence rates. As it had been suggested that tetra- 10 Spector M L, Stern R C. Pneumothorax in cystic fi brosis: a cycline exerted its effect mainly at 6 months,13 long- 26-year experience. Ann Thorac Surg 1989; 47: 204–207. term recurrence rate would be an important element 11 Almind M, Lange P, Viskum K. Spontaneous pneumothorax: to be included in future studies, and preferably with comparison of simple drainage, talc pleurodesis, and tetra- the presence of a control group to determine the ef- cycline pleurodesis. Thorax 1989; 44: 627–630. 12 Alfageme I, Moreno L, Huertas C, Vargas A, Hernandez J, fi cacy. However, the defi nitions of ‘short-term’ and Beiztegui A. Spontaneous pneumothorax. Long-term results ‘long-term’ recurrences have been arbitrary, and an with tetracycline pleurodesis. Chest 1994; 106: 347–350. optimal timing to measure the effi cacy of pleurodesis 13 Light R W, O‘Hara V S, Moritz T E, et al. Intrapleural 1346 The International Journal of Tuberculosis and Lung Disease

tetracycline for the prevention of recurrent spontaneous pneumo- thoracic surgery for spontaneous pneumothorax: outcome of thorax. Results of a Department of Veterans Affairs coopera- 189 cases. Int Surg 2004; 89: 185–189. tive study. JAMA 1990; 264: 2224–2230. 21 Tschopp J M, Brutsche M, Frey J G. Treatment of complicated 14 Rodriguez-Panadero F, Antony V B. Pleurodesis: state of the spontaneous pneumothorax by simple talc pleurodesis under tho- art. Eur Respir J 1997; 10: 1648–1654. racoscopy and local anaesthesia. Thorax 1997; 52: 329–332. 15 Berger R. Pleurodesis for spontaneous pneumothorax. Will the 22 Whitlow C B, Craig R, Brady K, Hetz S P. Thoracoscopic pleu- procedure of choice please stand up? Chest 1994; 106: 992– rodesis with minocycline vs talc in the porcine model. Surg 994. Endosc 1996; 10: 1057–1059. 16 Dryzer S R, Joseph J, Baumann M, Birmingham K, Sahn S A, 23 Chung C L, Chen Y C, Chang S C. Effect of repeated thora- Strange C. Early infl ammatory response of minocycline and centeses on fl uid characteristics, cytokines, and fi brinolytic activ- tetracycline on the rabbit pleura. Chest 1993; 104: 1585–1588. ity in malignant pleural effusion. Chest 2003; 123: 1188–1195. 17 Chen J S, Hsu H H, Chen R J, et al. Additional minocycline 24 Wolff A J, Anderson E D, Read C A. Predictors of pleural ad- pleurodesis after thoracoscopic surgery for primary spontane- hesion formation and success of pleurodesis in patients with ous pneumothorax. Am J Respir Crit Care Med 2006; 173: pleural effusion. J Bronchol 2004; 11: 6–11. 548–554. 25 Janssen J P, Collier G, Astoul P, et al. Safety of pleurodesis with 18 Chen J S, Tsai K T, Hsu H H, Yuan A, Chen W J, Lee Y C. talc poudrage in malignant pleural effusion: a prospective co- I ntrapleural minocycline following simple aspiration for initial hort study. Lancet 2007; 369: 1535–1539. treatment of primary spontaneous pneumothorax. Respir Med 26 Maskell N A, Lee Y C, Gleeson F V, Hedley E L, Pengelly G, 2008; 102: 1004–1010. Davies R J. Randomized trials describing lung infl ammation 19 Liu W L, Wang H C, Luh K T, Yang P C. Recurrent bilateral after pleurodesis with talc of varying particle size. Am J Respir pneumothoraces: a rare complication of miliary tuberculosis. Crit Care Med 2004; 170: 377–382. J Formos Med Assoc 2008; 107: 902–906. 27 Sahn S A. Talc should be used for pleurodesis. Am J Respir Crit 20 Luh S P, Tsai T P, Chou M C, Yang P C, Lee C J. Video-assisted Care Med 2000; 162: 2023–2024.

RÉSUMÉ

CONTEXTE : Peu d’études ont évalué l’effi cacité sclé- nécessité d’une ventilation mécanique durant la pleuro- rosante de la minocycline dans les pneumothorax spon- dèse et une fuite d’air persistante avant la pleurodèse tanés secondaires (SSP) et aucune n’a comparé spéci- ont été en association de façon indépendante avec l’échec fi quement avec le talcage son effi cacité sclérosante et son de l’intervention. On a noté de la douleur respectivement profi l de sécurité. dans 44,6% des groupes sous minocycline et 37,5% des SCHÉMA : Une analyse rétrospective a été menée chez groupes avec talcage. La douleur s’est manifestée plus des patients souffrant de SSP qui ont subi entre janvier fréquemment chez les patients recevant de fortes doses et décembre 2004 dans 12 hôpitaux publics de Hong de talc (⩾5 g ; P = 0,03). La détresse respiratoire a été Kong une pleurodèse à la minocycline ou par talcage. signalée respectivement chez 1,7% et 1,6% des groupes RÉSULTATS : Il y a eu 121 épisodes de pleurodèse par sous minocycline et après talcage. minocycline et 64 épisodes de pleurodèse par talcage. CONCLUSION : La minocycline et la boue de talc ont eu L’échec immédiat de l’intervention a été du même ordre des effi cacités comparables dans la SSP avec des taux de de grandeur dans le groupe minocycline et dans le groupe succès immédiats >70%. L’effet indésirable le plus talcage (21,5% vs. 28,1% ; P = 0,31). La présence d’une fréquent a été la douleur et la détresse respiratoire a été maladie pulmonaire interstitielle, des épisodes antérieurs peu fréquente. Les deux techniques semblent effi caces et de pneumothorax au nombre de deux ou davantage, la sûres pour la pleurodèse chimique dans les cas de SSP.

RESUMEN

MARCO DE REFERENCIA: Pocos estudios han evaluado tersticial, el antecedente de dos o más episodios de neu- la efi cacia de la esclerosis generada por la minociclina en motórax, la necesidad de ventilación mecánica durante casos de neumotórax y en ningún artículo se ha com- la pleurodesis y una fuga de aire persistente antes del parado específi camente su efi cacia esclerótica y seguri- procedimiento. Se presentó dolor en 44,6% de pacientes dad toxicológica con la del talco en suspensión en los del grupo tratado con minociclina y en 37,5% del grupo casos de neumotórax espontáneo secundario (SSP). tratado con talco. El dolor fue más frecuente en los pa- MÉTODOS: Se llevó a cabo un análisis retrospectivo de cientes que recibieron altas dosis de talco (a partir de pacientes con SSP, en quienes se practicó una pleuro- 5 g; P = 0,03). Se observó difi cultad respiratoria en desis química con minociclina o talco en suspensión en 1,7% de los casos con minociclina y en 1,6% del grupo 12 hospitales públicos entre enero y diciembre del 2004, tratado con talco. en Hong Kong. CONCLUSIÓN: La minociclina y la suspensión de talco RESULTADOS: Se encontraron 121 episodios de pleuro- presentaron efi cacias escleróticas comparables en los ca- desis con minociclina y 64 con suspensión de talco. La sos de SSP, con una tasa de éxito inmediato superior a tasa de fracaso inmediato del procedimiento fue equiva- 70%. El dolor fue la reacción adversa más frecuente y la lente en el grupo de minociclina y el grupo tratado con difi cultad respiratoria fue infrecuente. Ambos métodos la suspensión de talco (21,5% contra 28,1%; P = 0,31). parecen técnicas efi caces y seguras de pleurodesis química Los factores asociados en forma independiente con el en este tipo de pacientes. fracaso fueron la presencia de enfermedad pulmonar in-