Pneumothorax Clinical Trial
Official title:
Intrapleural Minocycline Following Simple Aspiration for Initial Treatment of Primary Spontaneous Pneumothorax: a Retrospective Study
The optimal initial management of primary spontaneous pneumothorax (PSP) remains controversial. This study was conducted to evaluate the safety and efficacy of additional minocycline pleurodesis after successful aspiration of the first episode of PSP.
Primary spontaneous pneumothorax (PSP) most commonly occurs in young, tall, lean males. The
estimated recurrence rate is 23-50% after the first episode. The high recurrence rate
stimulated the development of many different therapeutic approaches, ranging from
conservative treatment such as observation to more invasive therapies such as surgery, and
optimal treatment of patients presenting with a first episode of PSP remains controversial.
In the recently published British Thoracic Society (BTS) guidelines, simple aspiration is
recommended as the first line treatment for all PSP requiring intervention because this
treatment provided the advantage of reduced hospital admission rate and reduced length of
hospital stay when compared with chest tube drainage. However, the recurrence rate of this
procedure was around 30%, making it inappropriate as a standard of care.
Intrapleural instillation of a chemical irritant (chemical pleurodesis) is an effective way
to reduce the rates of recurrent spontaneous pneumothorax in surgical and non-surgical
patients. Previously, chemical pleurodesis had usually been administrated through chest tube
or thoracoscopy. Administration of sclerosing agents through intravenous needle catheter or
pigtail catheter after simple aspiration had never been reported and the safety and efficacy
remained unknown.
Because the recurrence rate after simple aspiration remains high, we began to instill
minocycline into the pleural cavity through the pigtail or intravenous needle catheter since
December 2005 to determine if this adjuvant is effective in reducing the rate of recurrence.
In the present study, we report our experience of minocycline pleurodesis in treating first
episode of PSP after successful aspiration of pneumothorax. The effects of this adjuvant
therapy were evaluated by comparing the outcomes of the patients who underwent simple
aspiration alone with those who underwent additional minocycline pleurodesis.
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Observational Model: Defined Population, Time Perspective: Longitudinal
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