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(Chest. 2004;125:1315-1320.)
© 2004 American College of Chest Physicians

An Audit of Medical Thoracoscopy and Talc Poudrage for Pneumothorax Prevention in Advanced COPD*

Pyng Lee, MD; Wee See Yap, MD; Wee Yang Pek, MD and Alan Wei Keong Ng, MD

* From the Department of Respiratory and Critical Care Medicine (Dr. Lee), Singapore General Hospital; and the Department of Respiratory Medicine (Drs. Yap, Pek, and Ng), Tan Tock Seng Hospital, Singapore.

Correspondence to: Pyng Lee, MD, Consultant, Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Outram Rd, Singapore 169608; e-mail: gm3lp{at}sgh.com.sg

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 FEV1 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 FEV1 of < 40% predicted died within 30 days of the procedure, yielding a mortality rate of 10%. FEV1 (in liters), FEV1 (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.

Key Words: COPD • pneumothorax • poudrage • talc • thoracoscopy






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