Effectiveness and safety of povidone iodine for prolonged lung air-leak after lung surgery

Abstract

Background Pulmonary surgery is often associated with postoperative prolonged parenchymal air-leak. The purpose of this study was to determine efficacy and safety of povidone iodine as treatment of prolonged parenchymal air-leak following all-types of lung surgery. Methods This prospective trial was conducted from June 2019 to December 2020, and designed under PanAfrican Clinical Trials Registry requirements. Patients having prolonged parenchymal air-leak were randomly allocated to povidone iodine protocol (Group A) or surveillance without povidone iodine (Group B). We collected the number of povidone iodine injections required before bubbling stopped, total drainage period, tolerance after injection, complications and side-effects. Comparative study was performed to evaluate povidone iodine efficacy. Results Following randomization, Group A included 19 patients, and Group B 21. Both groups were comparable. The mean drainage period was 9.21 days in Group A (6–14 days) and 15.62 days in Group B (7–31 days) ( p = 0.001). The mean hospitalization period was 11.05 days in Group A (7–16 days) and 18.9 days in Group B (9–38 days) ( p < 0.0001). The mean follow-up period was 6.8 months (3–18 months). No deaths were noted in either groups. Four side-effects were reported in Group A (21%) and four serious complications were noticed in Group B (19%). No recurrences were reported in Group A versus one recurrence of homolateral pneumothorax in Group B (4.76%). Conclusions Povidone iodine is an effective and safe solution for pleurodesis. It is associated with a low complication rate that remains acceptable, and could be proposed as treatment of prolonged parenchymal air-leak after lung resections.

Additional pleural painting with iodopovidone during video-assisted thoracoscopic bullectomy for primary spontaneous pneumothorax: an observational, single-center retrospective analysis

“…Fever was one of the most common complications, and it must be regarded as a response to the induced inflammation of pleura from chemical sclerosing. Other studies showed that talc pleurodesis yielded up to 31% of fever complications (20), while iodopovidone was associated with fever in 6.1-33% of cases (15,16). Another study comparing talc poudrage with iodopovidone solution by tube thoracostomy showed similar frequencies in terms of fever rates in both groups (21).…”

“…Nevertheless, several alternatives to talc have been explored in recent years. For example, intrapleural iodopovidone demonstrated its efficacy in recurrent pleural effusion (14) and pneumothorax (15,16). However, there is a lack of studies that firmly assessed the concentration of iodopovidone or specific instructions for its use within the pleural cavity.…”

Intraoperative prevention and conservative management of postoperative prolonged air leak after lung resection: a systematic review

“…For this reason, most of literature is about postoperative PAL conservative management, that can rely on fewer options than intraoperative air leak treatment. To date, in case of completely expansible residual lung parenchyma, PAL treatment may be safely attempted by autologous blood patch or chemical pleurodesis (37)(38)(39)(40)(41)(42), whereas in case of residual pleural space, applying suction to the chest drain is still the most effective option available (43)(44)(45)(46)(47)(48). In all cases, digital drainage systems are useful since they allow early patients' mobilization and a real time quantification of air flow (49)(50)(51).…”

“…They reported that Iodine pleurodesis showed favorable results compared with Doxycycline pleurodesis or drainage alone, since POAL and LOS was significantly shorter in the first group, at the cost of slightly increased thoracic pain and few allergic reactions (6%). Also, Chaari and colleagues (42) evaluated the role of Povidone Iodine injection to treat PAL, finding out that after a mean number of 2.11 treatments per patient, drainage period and LOS were significantly shorter if compared to those of untreated patients. In addition, morbidity in the group of untreated patients was more severe, including infections and respiratory distress probably due to persistently incomplete lung re-expansion.…”

Novel intrathoracic irrigation using ultrafine ozone bubbles in a rat empyema model

“…Reports of human clinical studies show that povidone-iodine is effective for empyema and pleural infection 3 , 4 . Moreover, pleurodesis using povidone-iodine against air leaks following lung surgery, malignant pleural effusion, and chylothorax has been successful, with the occurrence of only non-serious adverse events such as chest pain 5 – 7 . However, in Japan, it is currently not approved for use in body cavities because of concerns about tissue damage and residues 8 .…”