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Pleurodesis is a medical procedure in which part of the pleural cavity is artificially obliterated. It involves the adhesion of the visceral and the costal pleura. The mediastinal pleura is spared.
Sterile talc powder, administered intrapleurally via a chest tube, is indicated as a sclerosant to decrease the recurrence of malignant pleural effusions in symptomatic patients. It is usually performed at the time of a diagnostic thoracoscopy.
Povidone iodine is equally effective and safe as talc, and may be preferred because of easy availability and low cost.
Chemical pleurodesis is a painful procedure, and so patients are often premedication with a sedative and analgesics. A local anesthetic may be instilled into the pleural space, or an epidural catheter may be placed for anesthesia.
Alternatively, tunneled pleural catheters (TPCs) may be placed in an outpatient setting and often result in auto-pleurodesis, whereby portable vacuum bottles are used to evacuate the pleural fluid. Routine evacuation keeps the pleura together, resulting in physical agitation by the catheter, which slowly causes the pleura to scar together. This method, though the minimally invasive and minimal cost solution, takes an average of about 30 days to achieve pleurodesis and is therefore the slowest means of achieving pleurodesis among other modalities.
Conservative management of primary spontaneous pneumothorax is noninferior to interventional management, with a lower risk of serious adverse events.
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