Pleurodesis (Obliteration of Pleural Space )

• Indication
  • Massive effusion
  • Recurrent
  • Good symptomatic relief following evacuation
  • Reasonable lenth of expected life
• Usual clinical conditions where indicated
  • Malignant effusion (Most useful in Cancer breast, Ovarian malignancy and Lymhoma)
    • pH > 7.3 - over 80% success
  • Benign -  lymphangiomyomatosis, CHF, Cirrhosis, pneumothorax
• Contraindication
  • Negative pressure induced effusion (worsening symptoms during pleural evacuation)
    • Endobronchial obstruction
    • Thick pleural peel with trapped lung
• Methods
  • Chemical
    • Tetracycline (Not available anymore)
    • Doxycycline
    • Bleomycin. Expensive option.
    • Nitrogen mustard, Atabrine,
  • Surgical
    • Pleurectomy
    • Thoracoscopic Talc pleurodesis (Current favoured method)
  • Radiotherapy
    • Radioactive gold: (Used in the past. Requires special dispoition of body because of radioactive material)
    • External Radiation (Loose lung function, not used any more)

• Technique for chemical pleurodesis:
  • Primarily works by irritant effect on pleura.
  • Tube thoracostomy to completely evacuate fluid to enable irritants to effectively spread over pleural surface.
  • When space is drained or lung expanded, inject 250 mg lidocaine for anesthesia, reposition patient to get complete anesthesia
  • Then inject doxycycline 5-10 mg/kg in 50 ml, flush tube with 50 ml saline
  • Reposition patient to contact all pleural surfaces (studies indicate that this may not be necessary)
  • Clamp thetube for 2 hours
  • Unclamp tube, and return to suction
  • If 24 hour drainage exceeds 200 ml repeat the procedure.
  • Pull the chest tube once the drainage is less tha 150 ml in 24 hours.