Pleurodesis: Technique and indications [Pleurodese: Técnica e indicações]

Pulmonology Department, Universidade de São Paulo, School of Medicine, São Paulo, Brazil.
Jornal brasileiro de pneumologia: publicacao oficial da Sociedade Brasileira de Pneumologia e Tisilogia (Impact Factor: 1.02). 07/2006; 32(4):347-56. DOI: 10.1590/S1806-37132006001100014
Source: PubMed


Recurrent pleural effusion, which is commonly seen in clinical practice, compromises patient quality of life, especially in patients with advanced malignant disease. The therapeutic approach to the pleural space involves a wide range of techniques, including aggressive procedures such as pleurectomy. Among such techniques, pleurodesis is the most frequently used. Pleurodesis can be induced through the insertion of pleural catheters, as well as through major surgical procedures (such as thoracotomy). There are various recommended sclerosing agents, including talc (which is the most widely used), silver nitrate and, recently, proliferative cytokines. This article summarizes the principal approaches to the treatment of recurrent pleural effusion, pleurodesis in particular, addressing the indications for, as well as the advantages and disadvantages of, their application in daily pulmonology practice.

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    • "Pleurodesis can be induced through the insertion of pleural catheters, as well as through surgical procedures (such as thoracotomy). There are various recommended sclerosing agents, including talc (which is the most widely used), silver nitrate and, recently, proliferative cytokines [16]. Thoracostomy tubes are the mainstay of treatment for removing fluid or air from the pleural space. "
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    ABSTRACT: The management of patients with malignant pleural effusion (MPE) remains problematic. Various modalities are available in the management of MPE. However, optimal treatment is still controversial and there is no universal standard approach. Management options include observation, thoracentesis, indwelling pleural catheter (IPC) or chest tube placement and pleurodesis. The aim of the study To evaluate the efficacy, safety and tolerability of pigtail catheters in comparison to intercostal tubes in pleurodesis of malignant pleural effusions. Patients and methods This study was carried out at Chest Department, Zagazig University Hospitals during the period from January 2012 to September 2013. The study included 100 patients (39 males and 61 females with a mean age of 61.8 ± 11.3 years) with pleural effusion of malignant etiology. Patients were classified into two groups Group I: included 50 patients 18 males and 32 females with a mean age of 63.8 years who were subjected to pigtail catheter drainage then pleurodesis. Group II: included 50 patients 21 males and 29 females with a mean age of 61.8 years who were subjected to tube thoracotomy drainage then pleurodesis. Results As regards pleurodesis outcome, there was a high frequency of success in group I (33 patients, 66%) when compared with group II (27 patients, 54%). However, the difference is not statistically significant. As regards pleurodesis complications the higher frequency of complications was in group II (22 patients, 44%) when compared with group I (43 patients, 86%). These differences were statistically significant (P < 0.05). Conclusion Pigtail catheters could be considered a safe, easy, tolerable and effective alternative method in comparison to the traditional intercostal tubes in pleurodesis of malignant pleural effusions.
    Full-text · Article · Jan 2013
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    ABSTRACT: Pleurodesis is one of the best methods of controlling malignant pleural effusions (MPE), a distressing complication of metastatic disease. In recent studies of a wide range of pleural diseases, iodopovidone was used as a sclerosing agent for pleurodesis and demonstrated good results with low morbidity. The aim of this study was to evaluate the efficacy and safety of iodopovidone pleurodesis in MPE. A retrospective analysis was performed on patients with MPE who underwent pleurodesis at our institution between 2005 and 2008. All patients underwent instillation of 20 mL of 10% iodopovidone, 80 mL of normal saline and 2 mg/kg of lidocaine through a chest tube, which was clamped for 2 h. The tube was removed when the daily output of fluid was <200 mL. Data on the requirement for additional pleural procedures, adverse events and survival were collected. Sixty-one pleurodesis procedures were performed in 54 patients. No procedure-related mortality was observed. Adverse events occurred after 11 (18%) pleurodesis procedures. The most frequent complication was mild thoracic pain that occurred immediately after 10 (16.4%) procedures, and one patient developed pleural empyema that was treated with drainage and antibiotics. A success rate of 98.4% was observed. Except for the patient who developed pleural empyema, none of the other patients had recurrences of pleural fluid or required additional pleural procedures during the follow-up period (mean of 5.6 months). Iodopovidone pleurodesis was successful and was associated with only a few minor complications. It appears to be a good option for the management of recurrent MPE.
    No preview · Article · Nov 2009 · Respirology
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    ABSTRACT: Secondary hydatidosis is an important problem encountered during the surgical treatment of hydatid cysts. This study describes an experimental model of secondary hydatidosis by cyst inoculation, used to explore whether simultaneous inoculation of protoscolocidal agents could prevent secondary hydatidosis. Fertile cyst fluid was injected into the pleural space of rabbits alone (group 1, n = 8), and in combination with 2% albendazole solution (group 2, n = 8), 20% hypertonic saline (group 3, n = 8) or 10% povidone-iodine (group 4, n = 8). Computed tomography imaging of the thorax, indirect haemagglutination (IHA) titres and eosinophil counts were used to determine cyst development. After 16 months, three control rabbits had pneumothorax, seven had cysts and four had parenchymal nodules. Histopathological investigation of nodules revealed 87.5% cyst formation. Pleural thickening was observed in rabbits from all groups. Cyst formation rates, IHA titres and eosinophilia counts were higher in group 1 than in groups 2-4. This study demonstrated the experimental formation of secondary hydatidosis and found that topical protoscolocidal agents were beneficial in preventing cyst recurrence.
    Full-text · Article · Aug 2011 · The Journal of international medical research