Efficacy and safety of povidone-iodine pleurodesis in malignant pleural effusions

Abstract

Introduction:Malignant pleural effusion (MPE) is determined by the detection of malignant cells in pleural fluid or pleural tissue. Neoplasm of lung, breast, ovary and lymphoma are the causes of more than 75% of MPE. Pleurodesis is a usual technique in the management of MPE to achieve a symphysis between two layers of the pleura, and various chemical agents have been used in an attempt to produce pleurodesis. With regard to complications and limitations of these sclerosing agents, efficacy and safety of povidone-iodine have been investigated in this study.Materials and Methods:Between June 2014 and June 2016, 63 consecutive patients were admitted to the Department of Thoracic Surgery because of symptomatic MPE. After insertion of a chest tube, pleurodesis with instillation of povidone-iodine was performed. Thyroid and renal function tests were checked, and success rate as well as recurrence of MPE was monitored in the next follow-up visits.Results:The complete response to this procedure was about 53.57%, and failure of treatment was 10.71% with efficacy of 82.2%. The most common complication was pain during instillation (26.9%). Changes in thyroid and renal function tests were not significant.Conclusion:Povidone-iodine is a safe and effective agent with minor side effects in pleurodesis of patients with MPEs and can be used as an accessible and low-cost alternative than other sclerosing agents.

Pleurodesis with povidone iodine in patients with malignant pleural effusion in a tertiary center in Nigeria

“…and also in a study by Olivares et al . [ 2 , 8 , 31 ]. These patients had analgesia with xylocaine during the procedure, the post procedure pain was mild and required only mild analgesia (paracetamol).…”

Video-assisted thoracoscopic iodopovidone pleurodesis for malignant pleural effusions in moderate to high-risk Colombian patients

“…There is limited literature on the efficiency of VATS iodopovidone-iodine pleurodesis for MPEs. 5 - 11 A 2016 Cochrane review consisting of 62 randomized trials including a total of 3 428 patients taken to pleurodesis yielded no studies involving a VATS iodopovidone-iodine pleurodesis approach for MPEs. 13 Agarwal et al reported a meta-analysis evaluating N=157 patients with pleural effusions treated with iodopovidone pleurodesis; N=144 through chest tubes and N=121 through thoracoscopy (for pneumothorax).…”

“…Up to 90% of MPEs reoccur requiring repeated drainage, at this point permanent catheters may be placed, or pleurodesis considered if there is adequate lung expansion. 2 - 5 Contraindications for video-assisted thoracoscopic surgery (VATS) chemical pleurodesis include patient refusal, non-expanding lung, suspicion of current infection, concomitant adhesions requiring decortication, and less than one month of life expectancy. 2 , 3 Successful pleurodesis is defined as no re-accumulation for up to 30 days.…”

“… 2 , 3 Successful pleurodesis is defined as no re-accumulation for up to 30 days. 4 , 5 Pleurodesis effectiveness or success can be classified as either complete, showing no effusion recurrence during follow-up chest x-ray; partial, resulting in minor asymptomatic recurrence during follow-up, or failed pleurodesis. Failed pleurodesis can be further sub-classified as primary, meaning continued and persistent effusion despite pleurodesis with impossibility to remove chest tubes, or secondary, resulting in symptomatic recurrence during follow-up.…”

“…Failed pleurodesis can be further sub-classified as primary, meaning continued and persistent effusion despite pleurodesis with impossibility to remove chest tubes, or secondary, resulting in symptomatic recurrence during follow-up. 2 - 5 Since pleurodesis fails in up to 10%-40% of malignant pleural effusions, choosing the right patients for this procedure requires careful analysis. If pleurodesis fails or the patient has a trapped lung, intrapleural catheter placement becomes the treatment of choice.…”