Pleurodesis

• Pleurodesis is a medical procedure that seals the pleural space to prevent fluid or air buildup.
• It is primarily used for recurrent pleural effusions and pneumothorax.
• The procedure involves introducing an irritant (sclerosant) into the pleural space to induce inflammation and adhesion.
• Common side effects include pain and fever, with recovery typically involving pain management and monitoring.
• The goal is to permanently adhere the lung to the chest wall, eliminating the pleural space.

What is Pleurodesis?

Pleurodesis refers to a medical procedure performed to prevent the recurrence of fluid (pleural effusion) or air (pneumothorax) in the pleural space, which is the potential space between the two pleurae (visceral and parietal) that surround the lungs. This intervention intentionally creates an adhesion between the parietal and visceral layers of the pleura, effectively obliterating the pleural space. By doing so, it prevents the re-accumulation of substances that can compress the lung and impair breathing. The procedure is often considered for patients with malignant pleural effusions, which are a common complication of various cancers, affecting an estimated 150,000 people annually in the United States, according to the American Thoracic Society.

How the Pleurodesis Procedure Works

The Pleurodesis procedure explained involves several key steps aimed at inducing inflammation and subsequent adhesion within the pleural space. First, any existing fluid or air is drained from the pleural space, typically through a chest tube. Once the space is adequately drained, a sclerosing agent, known as a sclerosant, is introduced into the pleural cavity via the chest tube. Common sclerosants used include:

• Talc (most commonly used)
• Doxycycline
• Bleomycin

These agents are chosen for their ability to irritate the pleural surfaces. How does pleurodesis work? The sclerosant triggers an inflammatory response in the pleura, causing the two layers to become sticky and eventually fuse together. This fusion eliminates the potential space, thereby preventing future fluid or air accumulation. After the sclerosant is administered, the chest tube is often clamped for a period to allow the agent to distribute and act on the pleural surfaces. The patient may be asked to change positions to ensure even distribution. The chest tube is usually removed once drainage is minimal and there is evidence of successful pleurodesis, such as lung re-expansion and absence of fluid/air recurrence. The success rate of pleurodesis can vary depending on the underlying condition and the sclerosant used, but it generally ranges from 70-90% for malignant pleural effusions.

Pleurodesis Side Effects and Recovery

Pleurodesis side effects and recovery are important considerations for patients undergoing this procedure. Immediately following the procedure, patients commonly experience pain at the chest tube insertion site and within the chest, which is usually managed with analgesics. Fever is another frequent side effect, often a result of the inflammatory response induced by the sclerosant, and typically resolves within a few days. Other potential side effects, though less common, can include shortness of breath, nausea, vomiting, and in rare cases, acute respiratory distress syndrome or infection.

Recovery from pleurodesis involves careful monitoring and pain management. Patients typically remain hospitalized for a few days after the procedure to ensure the chest tube is functioning correctly and to manage any immediate side effects. Once discharged, patients are advised to rest and avoid strenuous activities for a period, as recommended by their physician. Follow-up appointments are crucial to monitor for any recurrence of fluid or air and to assess the overall success of the pleurodesis. While the procedure aims for a permanent solution, long-term follow-up helps ensure sustained relief and optimal respiratory function.