Chemical pleurodesis versus surgical intervention for persistent and recurrent pneumothoraces in cystic fibrosis

Background Pneumothorax is a potentially life-threatening complication for people with cystic fibrosis. Spontaneous pneumothorax is the presence of air in the pleural space and can be subdivided into first episode and recurrent. The recurrence of pneumothorax is when it occurs on the same side seven days or more after initial resolution. A pneumothorax is persistent if the air leak lasts for more than five days (Schidlow 1993). Managing spontaneous pneumothoraces is controversial and there is no standard treatment. Medical and surgical intervention are the two main categories for the treatment of recurrent pneumothoraces in people with cystic fibrosis. While surgical interventions are felt to be more effective in people without cystic fibrosis, the complications directly related to the procedure, as well as the post-operative complications make surgical interventions riskier for people with cystic fibrosis. Additionally, these interventions have the potential to make people with cystic fibrosis ineligible for lung transplantation in the future. Therefore, the benefits and side effects or disadvantages for the medical and surgical treatment of recurrent pneumothoraces in people with cystic fibrosis need to be systematically reviewed. Objectives To determine the clinical efficacy and safety of different treatment interventions for managing spontaneous persistent and recurrent pneumothoraces in people with cystic fibrosis. Search strategy We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group Trials Register which comprises references identified from comprehensive electronic database searches, handsearches of relevant journals and abstract books of conference proceedings. Date of the most recent search: 19 August 2008. Selection criteria Randomised and quasi-randomised controlled trials which compared the use of chemical pleurodesis to surgical interventions for the treatment of persistent and recurrent pneumothoraces in CF. Data collection and analysis No relevant trials were identified. Main results No trials were included in this review Author conclusions Pneumothorax is a potentially life-threatening complication for people with cystic fibrosis and the management of spontaneous pneumothoraces remains a topic of considerable controversy. Medical and surgical intervention are the two main categories for the treatment of recurrent pneumothoraces in this population. However, it is disappointing that neither intervention has been assessed by randomised controlled trials. This systematic review identifies the need for a multicentre randomised controlled trial assessing both efficacy and possible adverse effects of the use of chemical pleurodesis versus surgical interventions for the treatment of persistent and recurrent pneumothoraces in people with cystic fibrosis.