What is pleurodesis?

From the Guidelines

Pleurodesis is recommended for patients with symptomatic malignant pleural effusions (MPE) and expandable lung, using either talc poudrage or talc slurry, as it has been shown to reduce the need for additional pleural procedures and complications 1. The decision to use talc poudrage or talc slurry should be based on local expertise, the need for additional tissue for molecular-marker analysis, and patient-related factors, such as the presence of a chest tube 1. Key considerations for pleurodesis include:

• Complete drainage of the pleural fluid before the procedure
• Pain management, as the procedure can cause significant discomfort
• The use of talc as the most effective pleurodesis agent, with a complete success rate of 93% 1
• Potential complications, such as pain, fever, respiratory failure, and acute respiratory distress syndrome
• Contraindications, including trapped lung, active pleural infection, or significant comorbidities that increase procedural risks The most recent and highest quality study recommends the use of talc pleurodesis, with either poudrage or slurry, for patients with symptomatic MPE and expandable lung, as it improves outcomes and reduces complications 1.

From the Research

Definition and Purpose of Pleurodesis

• Pleurodesis is a medical procedure used to treat conditions such as malignant pleural effusion and persistent or recurrent spontaneous pneumothorax 2.
• The primary objectives of pleurodesis are to alleviate symptoms, decrease prolonged air leak, avoid recurrence, and improve quality of life 2.

Types of Pleurodesis

• Chemical pleurodesis utilizes chemical irritants, with talc being the most common due to its efficiency and success in lowering the rate of recurrence 2, 3, 4.
• Surgical pleurodesis with mechanical abrasion by videothoracoscopy is indicated primarily in the treatment of spontaneous pneumothorax 2, 5.
• Other substances used for pleurodesis include cytostatics, antibiotics, antiseptics, and autologous blood, although these are less frequently used 2.

Indications and Efficacy

• Pleurodesis is commonly used in the palliative treatment of malignant pleural effusion 2, 6, 3, 4.
• The procedure is also indicated in the treatment of spontaneous pneumothorax, hepatic hydrothorax, chylothorax, and cardiac effusion that does not respond to medical treatment 2, 5.
• Studies have shown that talc pleurodesis is effective in preventing the recurrence of pleural effusions, with a success rate significantly higher than that of control therapies 3, 4.

Comparison of Pleurodesis Techniques

• Thoracoscopic pleurodesis has been found to be more effective than medical pleurodesis, with a higher success rate and lower recurrence rate 3, 4.
• Catheter-based pleurodesis is a less invasive alternative to surgical pleurodesis, although its efficacy and safety are still being studied 5.
• A cost-effectiveness analysis found that talc pleurodesis was less costly than Pleurx catheter placement, although the choice of treatment should be based on individual patient needs and preferences 6.

Safety and Complications

• Pleurodesis can be associated with adverse events, such as fever, pain, and gastrointestinal symptoms, although these are not always reported in studies 3.
• The use of non-steroidal anti-inflammatory drugs in the postoperative period is not recommended, as it may interfere with hemostasis or the formation of adhesions 2.