pleurodes

Pleurodesis is a medical procedure aimed at obliterating the pleural space by promoting adhesion between the visceral and parietal pleura. By creating a fused pleural surface, it prevents the accumulation of air or fluid in the chest cavity and reduces the likelihood of recurrence after events such as pneumothorax or malignant pleural effusion.

There are two main approaches: chemical pleurodesis and mechanical pleurodesis. In chemical pleurodesis, a sclerosant is introduced into the pleural space to provoke inflammation and fibrous adhesion. Talc is the most commonly used agent, but alternatives include doxycycline, bleomycin, and iodopovidone. Mechanical pleurodesis relies on physical irritation of the pleural surfaces, often performed during thoracoscopy, sometimes with deliberate abrasion to induce adhesion. The procedure is frequently accompanied by chest tube drainage to evacuate air or fluid.

Indications include recurrent spontaneous pneumothorax or recurrent pleural effusions, particularly when ongoing drainage or repeated interventions are unlikely to be effective or well tolerated. It may be considered for persistent malignant effusions or other conditions where eliminating the pleural space would relieve symptoms and reduce hospitalizations.

Procedure and anesthesia considerations vary, but pleurodesis is typically performed under local anesthesia with sedation or general anesthesia. A chest tube is placed to drain the space, and the sclerosant is administered, or thoracoscopic instruments are used to abrade and seal the pleura.

Outcomes and risks: pleurodesis can significantly reduce recurrence rates in appropriately selected patients. Common adverse effects include chest pain and fever; less frequent complications include infection, bleeding, or respiratory distress. Contraindications include active pleural infection, uncorrected coagulopathy, or a patient unable to tolerate the procedure.