Pleurodesis is a medical procedure for the pleural space, which is the area between the lungs and chest wall. Its primary aim is to prevent fluid or air re-accumulation, offering relief from associated symptoms. It seals this space by encouraging the two pleural layers to adhere.
Understanding Pleurodesis
The lungs are enveloped by two thin membranes, the pleura. One layer, the visceral pleura, covers the lung surface, while the other, the parietal pleura, lines the inside of the chest wall. Normally, a small amount of lubricating fluid exists between these layers, allowing the lungs to glide smoothly during breathing.
However, certain medical conditions can disrupt this balance, leading to an abnormal buildup of fluid or air in the pleural space. Pleural effusion involves excess fluid accumulation, often caused by inflammation or conditions like cancer, heart failure, or pneumonia. A pneumothorax, or collapsed lung, occurs when air leaks into this space, pressing on the lung. The procedure works by inducing a controlled inflammatory response, forming fibrous adhesions that fuse the pleural layers together.
Methods of Pleurodesis
Pleurodesis can be performed using chemical or mechanical approaches. Chemical pleurodesis involves introducing a sclerosing agent into the pleural space to provoke an inflammatory reaction. This irritation causes the pleural surfaces to become sticky and bond together, sealing the space.
Common agents for chemical pleurodesis include sterile talc powder, doxycycline, and povidone-iodine. These substances cause inflammation, leading to fibrous adhesions. Mechanical pleurodesis achieves adhesion through physical irritation of the pleural surfaces. This is typically done by abrading or “scratching” the parietal pleura. A sterile surgical pad, gauze, or specialized abrader is used to rub the lining of the chest wall, promoting the fusion of the pleural layers.
The Procedure and Recovery
Before pleurodesis, patients undergo evaluation and may need to adjust medications. The procedure often begins with the insertion of a chest tube to drain accumulated fluid or air, allowing the lung to re-expand. For chemical pleurodesis, the sclerosing agent is then instilled through this chest tube.
Mechanical pleurodesis may be performed using a thoracoscopy, where a small camera and instruments are inserted through small incisions to abrade the pleural surfaces. After the agent is administered or abrasion is complete, the chest tube often remains in place for 24 to 72 hours. Recovery typically involves a hospital stay of two to five days, with pain management provided. Post-discharge care includes keeping the incision site clean and avoiding heavy lifting for several weeks, with a gradual return to normal activities.
Potential Outcomes and Considerations
Pleurodesis is an effective treatment for preventing the recurrence of fluid or air buildup in the pleural space, with high success rates. It aims to alleviate symptoms such as breathlessness and improve a patient’s overall comfort.
Common temporary effects may occur. Patients often experience chest pain, which can be managed with medication. A fever is also common, typically resolving within one to three days. Short-term breathlessness or breathing difficulties may arise due to the inflammation, but these usually subside within a few days. There is a small possibility of infection at the chest tube insertion site or within the chest cavity, which is usually treated with antibiotics.
Pleurodesis is typically considered for recurrent issues, when less invasive treatments have been unsuccessful, or to manage symptoms in patients with a limited life expectancy. For the procedure to be effective, the lung must be able to fully expand after any fluid or air has been drained.