Pleurodesis

Pleurodesis is a procedure that induces adhesion between the visceral and parietal pleura to obliterate the pleural space, preventing recurrent pleural effusions or pneumothorax.

Indications

• Recurrent malignant pleural effusion (e.g., lung cancer, mesothelioma).
• Recurrent spontaneous pneumothorax (especially if persistent air leak).
• Chylothorax (persistent lymphatic leakage).

Methods of Pleurodesis

1. Chemical Pleurodesis (Most Common)
   • Agents Used:
     • Talc (Talc slurry or poudrage) – Most effective, low recurrence.
     • Doxycycline or tetracycline – Alternative, but more painful.
     • Bleomycin – Used occasionally, but expensive.
   • Procedure:
     • Drain pleural effusion completely via chest tube.
     • Instill chemical agent via chest tube.
     • Clamp tube for 1–2 hours while repositioning patient every 15–30 minutes.
     • Unclamp and continue drainage.
     • Remove chest tube once output is minimal (~<150 mL/day).
2. Surgical Pleurodesis (Video-Assisted Thoracoscopic Surgery, VATS)
   • Talc Poudrage: Insufflation of talc under direct vision.
   • Mechanical Pleurodesis: Pleural abrasion or pleurectomy (more invasive).