Pleurodesis
Pleurodesis is a medical procedure aimed at binding the pleural membranes surrounding the lungs to facilitate easier breathing, particularly in patients with lung cancer experiencing malignant pleural effusions. Normally, the pleural cavity is filled with a fluid that allows the lungs to expand smoothly; however, excess fluid can hinder this process, making breathing difficult. During pleurodesis, a sclerosant—such as sterile talc or other agents—is introduced into the pleural space after draining the excess fluid. This irritant causes inflammation that promotes the membranes to stick together, thereby preventing further fluid accumulation and improving lung function.
The procedure can be performed in a hospital or outpatient setting, often involving local anesthesia and a chest tube insertion. Post-procedure, patients may experience mild complications like a low-grade fever or discomfort, but serious risks include respiratory distress, infection, and bleeding. While pleurodesis is typically effective in relieving symptoms, it may need to be repeated in some cases. Overall, this intervention is crucial for improving the quality of life in patients facing significant respiratory challenges due to lung conditions.
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Pleurodesis
DEFINITION: Pleurodesis is the binding together of the pleural membranes surrounding the lungs to make breathing easier.
Cancers treated:Mesothelioma, lung cancer
Why performed: Pleurodesis is used to help lung cancer patients with malignant pleural effusions breathe more easily. Normally, the membranes of the pleural cavity surrounding the lungs are coated with fluid that provides surface tension to make them adhere, causing the lungs to inflate when the diaphragm moves during inspiration. Extra fluid in this cavity (pleural effusion) makes breathing difficult because pleural surfaces do not stick together, and the lungs do not have room to expand completely. During pleurodesis, the extra fluid is removed, and a sclerosant (chemical irritant) such as sterile talc or an antibiotic is injected into the pleural cavity. The irritation causes inflammation in the membranes, which makes them stick together and also prevents more fluid accumulation. Due to concerns over the safety of talc, other agents, including iodopovidone, silver nitrate, transforming growth factor beta (TGFβ), OK432, lipoteichoic acid, and tigecycline may be used. Alternatively, the surfaces can be mechanically irritated (scraped) during a surgical procedure.
Patient preparation: Patients are typically hospitalized, although pleurodesis can also be done on an outpatient basis. Patients should report any allergies to medications or other substances, such as iodine. They may be asked to stop taking medications that can increase the risk of bleeding.
Steps of the procedure: The skin and chest wall are injected with a local anesthetic, and a chest tube is inserted into the pleural cavity (a procedure called a thoracotomy). A chest X-ray is taken to ensure proper placement. Any fluid in the cavity is drained, in some cases, over several days. Before injection of the sclerosant, the patient may receive an or sedative to prevent discomfort. Sometimes, the patient is asked to rotate from side to side. Then, the excess sclerosant is drained, and the doctor removes the chest tube, which may take only a few hours. An occlusive dressing is applied over the opening to prevent air from entering the chest. Medical thoracoscopy, video-assisted thoracoscopy, and open thoracotomy are other methods of performing pleurodesis. Further, indwelling pleural catheters have offered another alternative for fluid draining.
After the procedure: Patients are observed for serious complications such as respiratory distress, a collapsed lung, or bleeding. The occlusive dressing is typically left in place for two days; if stitches are used to close the opening, then they may remain in place for a week. Additional pain medication may be needed once the anesthetic has worn off. A low-grade fever is a common response to the inflammation.
Risks: The risks of pleurodesis include respiratory distress, infection, a collapsed lung, and bleeding. Patients may also have a reaction to the irritant.
Results: After a successful pleurodesis, the patient will find breathing easier. This procedure may be repeated if needed.
Bibliography
Choong, Cliff K. C., ed. Thoracic Surgery Clinics: Management of Benign and Malignant Pleural Effusions, vol. 23.1, 2013, pp. 1–102.
Freeman, Richard K., et al. "A Propensity-Matched Comparison of Pleurodesis or Tunneled Pleural Catheter for Heart Failure Patients with Recurrent Pleural Effusion." Annals of Thoracic Surgery, vol. 97.6, 2014, pp. 1872–77.
Inderbitzi, Rolf Gilbert Carl, et al., eds. Minimally Invasive Thoracic and Cardiac Surgery: Textbook and Atlas. New York: Springer, 2012.
Light, Richard W. Pleural Diseases. 6th ed., Philadelphia: Lippincott, 2013.
Marcin, Judith. “Pleurodesis: Complications, Side Effects, and Recovery.” Healthline, 23 Mar. 2018, www.healthline.com/health/pleurodesis. Accessed 19 June 2024.
“Treatment for Fluid on the Lung (Pleurodesis) - Mesothelioma.” Cancer Research UK, 28 June 2023, www.cancerresearchuk.org/about-cancer/mesothelioma/treatment/fluid-lung-pleurodesis. Accessed 19 June 2024.
“What is Pleurodesis: Types, Recovery & Complications.” Cancer Treatment Centers of America, 27 Sept. 2022, www.cancercenter.com/treatment-options/pleurodesis. Accessed 19 June 2024.
Xia, Huan, et al. "Efficacy and Safety of Talc Pleurodesis for Malignant Pleural Effusion: A Meta-Analysis." PLoS ONE, vol. 9, no. 1, 2014, doi.org/10.1371/journal.pone.0087060. Accessed 19 June 2024.