Pleural effusions

[Rich66]

Iodoprovidone exhibits safety and efficiency in management of malignant pleural effusion

3. February 2010 05:1LINK



Chest. 2002 Aug;122(2):581-3.
Iodopovidone pleurodesis for recurrent pleural effusions.

Olivares-Torres CA, Laniado-LaborÃ*n R, Chávez-GarcÃ*a C, León-Gastelum C, Reyes-Escamilla A, Light RW.
Department of Surgery, Hospital General de Tijuana, Tijuana, Mexico.
Comment in:

• Chest. 2003 Apr;123(4):1318-9; author reply 1319.

STUDY OBJECTIVE: Chemical pleurodesis may be the best available treatment for recurrent and troublesome pleural effusions when the underlying cause cannot be corrected. A wide variety of pleural irritants have been used, but the search for the ideal agent for pleurodesis continues. The purpose of our study is to evaluate the efficacy and safety of iodopovidone as an agent for pleurodesis in patients with recurrent pleural effusion. DESIGN AND SETTING: Multicenter prospective study. INTERVENTION: The pleurodesis solution consisted of a mixture of 20 mL 10% iodopovidone and 80 mL normal saline solution. It was infused and left in the pleural cavity for 2 h. In 12 patients, pleurodesis was performed through a tube thoracostomy, and in the remaining 40 patients it was carried out at the end of diagnostic thoracoscopy. RESULTS: Fifty-two patients were included, with a mean (+/- SEM) age of 56.6 +/- 1.84 years. Eighty-five percent of the cases were related to a malignant neoplasm. A complete response, with no reaccumulation of fluid during follow-up, was obtained in 50 patients (96.1%). A second procedure was successful in the two remaining patients. Three patients (5.8%) experienced intense pleuritic pain and systemic hypotension after the instillation of the sclerosing agent. They recovered without incident. The mean length of follow-up was 13 +/- 1.46 months, with a median of 8.5 months. There were no 30-day postoperative deaths. CONCLUSIONS: Iodopovidone is an effective, safe, readily available, and inexpensive alternative to achieve chemical pleurodesis in cases of recurrent, incapacitating effusions, regardless of etiology.

PMID: 12171835 [PubMed - indexed for MEDLINE]




In the USA each year, 200,000 cancer patients suffer from a malignant pleural effusion - development of excessive fluid (pleural effusion) in the chest. Several litres of such fluid can accumulate, and many patients suffer from significant breathlessness and distress. One in four patients with lung cancer, one in every three with breast cancer and most of the patients with mesothelioma will develop a malignant effusion. The current strategy is to induce a pleurodesis (seal the pleural cavity with a chemical agent so no fluid can accumulate). However existing agents are far from perfect, with most producing significant side effects while delivering low success rates.
A recent issue of Respirology published by Wiley-Blackwell features two papers that propose the use of a new alternative pleurodesing agent, Iodoprovidone. They evaluate iodopovidone as a pleurodesis agent and found that it demonstrated good efficiency and safety, making it a good option in the management of malignant pleural effusion.
"There is not only a need to identify ideal pleurodesis agents, but also to standardize and optimize research tools to evaluate pleurodesis success in malignant effusions. In combination, these papers are complementary and warrant a critical appraisal of the current state of clinical research in malignant pleural effusion", said Andreas H. Diacon in an editorial published in the same issue of Respirology.
Pleurodesis is widely used to manage pleural diseases, such as malignant pleural effusion, by promoting pleural obliteration and preventing accumulation of air or fluid in the pleural space. This process would ideally alleviate shortness of breath, cough and pain associated with the presence of tumor and fluid in the pleural space.
In the paper, "Iodopovidone is as effective as doxycycline in producing pleurodesis in rabbits", researchers used a rabbit model to compare the effectiveness of iodopovidone in causing pleurodesis with that of doxycycline.
The study found that iodopovidone can induce pleurodesis as efficaciously as doxycycline and demonstrated that the desired outcome of pleurodesis can be achieved without prohibitive toxicity with a range of doses applicable to humans.
The other paper "Efficacy and safety of iodopovidone pleurodesis in malignant pleural effusions" is a retrospective analysis of iodopovidone pleurodesis in patients with malignant pleural effusions treated in a tertiary cancer institution.
Lead author Jose D.A. Neto said, "Out of the 61 pleurodesis procedures performed, no mortality was observed and less than 20 per cent presented complications. With the success rate of about 99 percent, iodopovidone appears to be a good option for the recurrent malignant pleural effusion."
SOURCE Respirology, Wiley-Blackwell





Thorac Cardiovasc Surg. 2009 Feb;57(1):42-6. Epub 2009 Jan 23.
Recurrent pleural effusion: who benefits from a tunneled pleural catheter?

Schneider T, Reimer P, Storz K, Klopp M, Pfannschmidt J, Dienemann H, Hoffmann H.
Department of Thoracic Surgery, Thoraxklinik University of Heidelberg, Heidelberg, Germany. thomas.schneider@thoraxklinik-heidelberg.de
Recurrent malignant pleural effusion (MPE) is a common concomitant phenomenon of malignant disease, which can worsen the patient's quality of life and lead to significant morbidity. Tunneled indwelling pleural catheters (TIPC) offer new modalities in patients with recurrent MPE and impaired dilatability of the lung. We report on our experience with 100 consecutive patients suffering from recurrent benign (n = 12) and malignant pleural effusion (n = 88) who were treated with TIPC. The catheter was placed during a VATS procedure or under local anesthesia in an open technique. The median residence time of the TIPC was 70 days; spontaneous pleurodesis was achieved in 29 patients. The rate of complications was low: pleura empyema (n = 4), accidental dislodgement (n = 2), malfunction of the drainage (n = 3). In conclusion, TIPC is a useful method for the palliative treatment of patients with recurrent malignant or nonmalignant pleural effusions and 3 groups of patients seem to benefit most: a) patients with the intraoperative finding of a trapped lung in diagnostic VATS procedure; b) patients after a history of repeated pleuracenteses or previously failed attempts at pleurodesis; c) patients in a reduced condition with a limited lifespan due to underlying disease.

PMID: 19169996 [PubMed - indexed for MEDLINE]



Med Sci Monit. 2003 Jun;9(6):PI54-9.
Talc powder vs doxycycline in the control of malignant pleural effusion: a prospective, randomized trial.

Kuzdzał J, Sładek K, Wasowski D, Soja J, Szlubowski A, Reifland A, Zieliński M, Szczeklik A.
Department of Thoracic Surgery, Specialized Hospital of Pulmonary Medicine, Zakopane, Poland. jaroslaw@mp.pl
BACKGROUND: Malignant pleural effusion is a common problem in advanced cancers, contributing to the poor quality of life in this group of patients. The aim of the study was to assess the efficiency of talc powder and doxycycline in pleurodesis in patients with malignant pleural effusion in comparable conditions. MATERIAL/METHODS: Of 52 patients screened, 33 entered the trial. They were randomized to the talc group (n=18) and the doxycycline group (n=15). Both groups were comparable with regard to age, sex and the most important variables influencing effectiveness of the procedure, i.e. primary malignancy and stage of metastatic involvement of the pleura. Efficiency of pleurodesis was prospectively assessed. RESULTS: The analysis of short-term effectiveness of pleurodesis in the first 33 patients has shown a highly significant difference in favor of talc powder (p=0.009); this difference was the reason for terminating the randomization. Further observation has revealed in the doxycycline group an increasing number of patients with fluid reaccumulation, as time went by; this was not observed in the talc group. A statistical analysis of the long-term effectiveness of both agents studied has shown a more significant difference in favor of the talc powder (p=0.00003). CONCLUSIONS: Talc powder is superior to doxycycline in achieving pleurodesis in patients with malignant pleural effusion, in both short- and long-term observations.

PMID: 12824959 [PubMed - indexed for MEDLINE]