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

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.