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pleurodesis; chemical pleurodesis
Indications:
1) recurrent pneumothorax
2) recurrent pleural effusion
Procedure:
1) pleural instillation of sclerosing agent (sclerotherapy) through a chest tube
2) sclerosing agent mixed in 30 mL of saline
a) tetracycline (15 mg/kg)
b) doxycycline (10 mg/kg)
c) minocycline (5 mg/kg)
d) bleomycin
e) talc (2.5-10 g) - 90% effective
3) surgical pleurodesis may be effective in closing pleural space when chemical agents fail
Management:
- NSAIDs vs opiates results in no significant difference in pain scores but is associated with more rescue medication
- placement of smaller 12F chest tubes vs 24F chest tubes is associated with a statistically significant but clinically modest reduction in pain but fails to meet noninferiority criteria for pleurodesis efficacy [3]
Related
pleural effusion
pneumothorax
Specific
thorascopy with pleurodesis
General
cardiothoracic surgery
sclerotherapy (phlebosclerosis)
References
- Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed)
Lippincott-Raven, Philadelphia, 1998, pg 773
- Medical Knowledge Self Assessment Program (MKSAP) 11, 17,
American College of Physicians, Philadelphia 1998, 2015
- Rahman NM et al
Effect of Opioids vs NSAIDs and Larger vs Smaller Chest Tube
Size on Pain Control and Pleurodesis Efficacy Among Patients
With Malignant Pleural Effusion: The TIME1 Randomized Clinical
Trial.
JAMA. 2015 Dec 22-29;314(24):2641-53
PMID: 26720026