Pleurodesis is a medical procedure in which part of the
pleural space
The pleural cavity, or pleural space (or sometimes intrapleural space), is the potential space between the pulmonary pleurae, pleurae of the pleural sac that surrounds each lung. A small amount of serous fluid, serous pleural fluid is maintained ...
is artificially obliterated. It involves the adhesion of the visceral and the costal pleura. The mediastinal pleura is spared.
Uses
Pleurodesis is performed to prevent recurrence of
spontaneous pneumothorax or
pleural effusion
A pleural effusion is accumulation of excessive fluid in the pleural space, the potential space that surrounds each lung.
Under normal conditions, pleural fluid is secreted by the parietal pleural capillaries at a rate of 0.6 millilitre per kilog ...
, and can be done chemically or mechanically. It is generally avoided in patients with
cystic fibrosis
Cystic fibrosis (CF) is a genetic disorder inherited in an autosomal recessive manner that impairs the normal clearance of Sputum, mucus from the lungs, which facilitates the colonization and infection of the lungs by bacteria, notably ''Staphy ...
if possible, because
lung transplantation
Lung transplantation, or pulmonary transplantation, is a surgical procedure in which one or both lungs are replaced by lungs from a donor. Donor lungs can be retrieved from a living or deceased donor. A living donor can only donate one lung lobe ...
becomes more difficult following this procedure. Previous pneumothorax with or without pleurodesis is not a contraindication to subsequent lung transplantation.
Chemical
Chemicals such as
bleomycin
-13- (1''H''-imidazol-5-yl)methyl9-hydroxy-5- 1''R'')-1-hydroxyethyl8,10-dimethyl-4,7,12,15-tetraoxo-3,6,11,14-tetraazapentadec-1-yl}-2,4'-bi-1,3-thiazol-4-yl)carbonyl]amino}propyl)(dimethyl)sulfonium
, C=55 , H=84 , N=17 , O=21 , S=3
, SMI ...
,
tetracycline
Tetracycline, sold under various brand names, is an antibiotic in the tetracyclines family of medications, used to treat a number of infections, including acne, cholera, brucellosis, plague, malaria, and syphilis. It is available in oral an ...
(e.g.,
minocycline
Minocycline, sold under the brand name Minocin among others, is a tetracycline antibiotic medication used to treat a number of bacterial infections such as some occurring in certain forms of pneumonia. It is generally (but not always) less pre ...
),
povidone-iodine
Povidone-iodine (PVP-I), also known as iodopovidone, is an antiseptic used for skin disinfection before and after surgery. It may be used both to disinfect the hands of healthcare providers and the skin of the person they are caring for. It may ...
, or a
slurry
A slurry is a mixture of denser solids suspended in liquid, usually water. The most common use of slurry is as a means of transporting solids or separating minerals, the liquid being a carrier that is pumped on a device such as a centrifugal pu ...
of
talc
Talc, or talcum, is a clay mineral composed of hydrated magnesium silicate, with the chemical formula . Talc in powdered form, often combined with corn starch, is used as baby powder. This mineral is used as a thickening agent and lubricant ...
can be introduced into the pleural space through a chest drain. The instilled chemicals cause irritation between the parietal and the visceral layers of the pleura which closes off the space between them and prevents further fluid from accumulating.
Pharmacy-prepared chemicals for pleurodesis should be clearly labeled "NOT FOR IV ADMINISTRATION"
to avoid potentially fatal wrong-site medication errors.
, administered intrapleurally via a
chest tube
A chest tube (also chest drain, thoracic catheter, tube thoracostomy or intercostal drain) is a drain (surgery), surgical drain that is inserted through the chest wall and into the pleural space or the Mediastinum. The insertion of the tube is som ...
, is indicated as a
sclerosing agent to decrease the recurrence of malignant pleural effusions in symptomatic patients. It is usually performed at the time of a diagnostic thoracoscopy.
Povidone iodine is equally effective and safe as talc, and may be preferred because of easy availability and low cost.
Chemical pleurodesis is a painful procedure, and so patients are often
premedicated with a sedative and analgesics. A
local anesthetic
A local anesthetic (LA) is a medication that causes absence of all sensation (including pain) in a specific body part without loss of consciousness, providing local anesthesia, as opposed to a general anesthetic, which eliminates all sensati ...
may be instilled into the pleural space, or an
epidural
Epidural administration (from Ancient Greek ἐπί, "upon" + '' dura mater'') is a method of medication administration in which a medicine is injected into the epidural space around the spinal cord. The epidural route is used by physicians ...
catheter may be placed for anesthesia.
Surgical
Surgical pleurodesis, also known as mechanical or abrasive pleurodesis, may be performed via
thoracotomy
A thoracotomy is a surgical procedure that involves cutting open the chest wall to gain access into the pleural cavity, It is mostly performed by specialist cardiothoracic surgeons, although emergency physicians or paramedics occasionally also ...
or
thoracoscopy
Thoracoscopy is a medical procedure involving internal examination, biopsy and/or resection/drainage of disease or masses within the pleural cavity, usually with video assistance. Thoracoscopy may be performed either under general anaesthesia o ...
. This involves mechanically irritating the apical and the costal
pleura
The pleurae (: pleura) are the two flattened closed sacs filled with pleural fluid, each ensheathing each lung and lining their surrounding tissues, locally appearing as two opposing layers of serous membrane separating the lungs from the med ...
, often with a scratchpad (a small
foam pad with
coated abrasive) normally used for cleaning
electrocautery
Cauterization (or cauterisation, or cautery) is a medical practice or technique of burning a part of a body to remove or close off a part of it. It destroys some tissue in an attempt to mitigate bleeding and damage, remove an undesired growth, o ...
blade tips. Moreover,
surgical removal of parietal pleura is an effective way of achieving stable pleurodesis.
Alternatively, tunneled pleural catheters (TPCs) may be placed in an outpatient setting and often result in auto-pleurodesis, whereby portable vacuum bottles are used to evacuate the pleural fluid. Routine evacuation keeps the pleura together, resulting in physical agitation by the catheter, which slowly causes the pleura to scar together. This method, though the minimally invasive and minimal cost solution, takes an average of about 30 days to achieve pleurodesis and is therefore the slowest means of achieving pleurodesis among other modalities.
Conservative management of primary spontaneous pneumothorax is noninferior to interventional management, with a lower risk of serious adverse events.
References
External links
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{{Respiratory system surgeries and other procedures
Respiratory system surgery
Thoracic surgical procedures
Pulmonary thoracic surgery