🔅 PLEURODESIS

– Pleurodesis is a medical procedure that aims to prevent the recurrence of fluid or air accumulation in the pleural space, which is the area between the lung and the chest wall.

– Pleural effusion and pneumothorax are two common conditions that cause fluid or air to build up in the pleural space, leading to symptoms such as shortness of breath, chest pain, and coughing.

– Pleurodesis works by creating inflammation and scarring of the pleural membranes, which makes them stick together and eliminates the space where fluid or air can collect.

There are two main types of pleurodesis:

🔅 Chemical.

🔅 Mechanical.

– Chemical pleurodesis involves injecting a substance (called a sclerosant) into the pleural space through a chest tube or a thoracoscope. The sclerosant irritates the pleural membranes and causes them to adhere.

– Mechanical pleurodesis involves physically scraping or rubbing the pleural membranes with a surgical instrument or a dry gauze to create inflammation and adhesion. Mechanical pleurodesis is usually done during a surgical procedure such as video-assisted thoracic surgery or open thoracotomy.

– The choice of the type and agent of pleurodesis depends on several factors, such as the underlying cause of the pleural effusion or pneumothorax, the patient's preference and condition, the availability and cost of the sclerosant, and the expertise of the doctor. Some of the most commonly used sclerosants for chemical pleurodesis are talc, doxycycline, and bleomycin.

• Talc is a mineral powder that is considered the most effective and widely used sclerosant.

• Doxycycline is an antibiotic that has anti-inflammatory and anti-fibrotic properties.

• Bleomycin is a chemotherapy drug that has cytotoxic and immunomodulatory effects.

– The procedure of pleurodesis is usually done under local or general anesthesia, depending on the type and method of pleurodesis.

• The patient may need to stay in the hospital for a few hours or days after the procedure, depending on the amount of fluid or air drained, the type of sclerosant used, and the occurrence of any complications.

• The patient may also need to take painkillers, antibiotics, and anti-inflammatory drugs to manage the pain, infection, and inflammation caused by the procedure.

– The effectiveness of pleurodesis varies depending on the type and agent of pleurodesis, the underlying cause of the pleural effusion or pneumothorax, and the patient's response to the procedure. In general, pleurodesis has a success rate of 60% to 90% in preventing the recurrence of fluid or air accumulation in the pleural space. However, some studies have reported lower or higher success rates depending on the type and agent of the pleurodesis. For example, a systematic review of 50 studies found that thoracoscopic talc poudrage had a success rate of 2.5% to 10.2%, while VATS talc poudrage had a success rate of 0% to 3.2%. A meta-analysis of 14 studies found that doxycycline had a success rate of 71%, while bleomycin had a success rate of 54%.

– A randomized controlled trial of 726 patients found that tetracycline had a success rate of 67%, while a case series of 270 patients found that autologous blood patch pleurodesis had a success rate of 84%.

Pleurodesis is generally a safe and well-tolerated procedure, but it may have some potential complications and side effects.

– Some of the possible complications of pleurodesis are infection, bleeding, empyema (pus in the pleural space), bronchopleural fistula (an abnormal connection between the bronchus and the pleural space), pneumothorax, respiratory failure, and death.

– Some of the possible side effects of pleurodesis are fever, chest pain, cough, dyspnea (difficulty breathing), nausea, vomiting, rash, and allergic reaction. The frequency and severity of these complications and side effects depend on the type and agent of pleurodesis, the patient's condition, and the quality of care.

– Pleurodesis is a procedure that has been used for decades to treat pleural effusion and pneumothorax, but it is still evolving and improving. There are ongoing studies and trials to compare the efficacy and safety of different types and agents of pleurodesis, to optimize the dose and timing of sclerosant administration, to identify the predictors and biomarkers of pleurodesis success, and to develop new and alternative methods of pleurodesis.

▶️ According to some of the current studies on pleurodesis:

🔅 EPIToME (Early Pleurodesis via IPC with Talc for Malignant Effusion)

– A randomized controlled trial that compares the efficacy and safety of early pleurodesis with talc via an indwelling pleural catheter (IPC) versus standard IPC management in patients with malignant pleural effusion.

🔅 TIME2 (Talc In Malignant Effusion 2)

– A randomized controlled trial that compares the efficacy and safety of talc pleurodesis via IPC versus IPC alone in patients with malignant pleural effusion.

🔅 AMPLE (Autologous Blood Patch Pleurodesis versus Manual Aspiration for Spontaneous Pneumothorax)

– A randomized controlled trial that compares the efficacy and safety of autologous blood patch pleurodesis versus manual aspiration in patients with primary spontaneous pneumothorax.

🔅 EASE (Efficacy and Safety of Eloesser Flap)

– A randomized controlled trial that compares the efficacy and safety of Eloesser flap (a surgical procedure that creates an opening in the chest wall to drain the pleural space) versus chemical pleurodesis in patients with chronic empyema.

– Now you could be wondering....

What are the symptoms of pleural effusion and pneumothorax?

– Pleural effusion and pneumothorax are two conditions that affect the pleural space, which is the area between the lung and the chest wall. They have some common and some different symptoms, as follows:

• Pleural effusion is the build-up of excess fluid in the pleural space, which can cause pressure on the lung and reduce its ability to expand. The symptoms of pleural effusion may include:

• Chest pain, especially when breathing in deeply. Shortness of breath, Coughing , and Fever.

• Some patients with pleural effusion have no symptoms, and the condition is discovered on a chest X-ray that is performed for another reason.

– Pneumothorax is the presence of air in the pleural space, which can cause the lung to collapse partially or completely. The symptoms of pneumothorax may include:

• Sudden chest pain.

• Shortness of breath.

• Tightness in the chest.

• Rapid breathing and heartbeat.

• Bluish skin caused by a lack of oxygen.

• A dry, hacking cough.

– Both pleural effusion and pneumothorax can be caused by various factors, such as chest injury, lung disease, infection, mechanical ventilation, or rupture of air blisters. They can be diagnosed by physical examination, blood tests, and imaging tests, such as chest X-ray, ultrasound, or CT scan. They can be treated by removing the excess fluid or air from the pleural space, using methods such as needle aspiration, chest tube, pleurodesis, or surgery. The treatment depends on the cause, severity, and type of the condition, and the patient's overall health.