If a pneumothorax persists after chest tube drainage due to a persistent air leak, which procedure may be required?

• A. Increased oxygen alone
• B. Observation with no intervention
• C. Immediate surgical repair
• D. Pleurodesis

Answer: (D)

When a pneumothorax continues despite chest tube drainage, it means there’s ongoing communication between the lung and the pleural space that the tube hasn’t sealed. The goal then becomes eliminating the pleural space to stop air from reaccumulating. Pleurodesis achieves this by causing the visceral and parietal pleura to stick together, effectively obliterating the space where air can collect. This can be done chemically (for example, talc or doxycycline) or mechanically, often during a thoracoscopic procedure. It’s a durable solution for a persistent air leak or recurrent pneumothorax, especially when a direct surgical repair of the leak isn’t feasible or as an adjunct when long-term recurrence risk is a concern. While high-flow oxygen can help reabsorb pleural air, it won’t fix an ongoing leak, and observation alone allows the leak to persist. Immediate surgical repair of blebs is an option in some cases, but pleurodesis is a common, effective approach to definitively stop the leak and prevent recurrence.