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2005, Number 2

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Rev Inst Nal Enf Resp Mex 2005; 18 (2)

Pleurodesis in malignant pleural effusions

Ibarra-Pérez C

Language: Spanish
References: 39
Page: 123-131
PDF size: 78.23 Kb.


ABSTRACT

Traditionally, pleurodesis has been attempted in patients with confirmed malignant tumors with recurring pleural effusions of more than half the size of the hemithorax, dyspnea that is relieved by evacuation of the fluid, a lung able to reach the chest wall and the expectation of a reasonably long survival period. Pleurodesis can be done at the bedside, the emergency room, in a procedure room by medical thoracoscopy under local anesthesia and sedation, or in the operating room by VATS under general anesthesia, introducing an sclerosing agent and/or producing pleural abrasion by different means. We propose “first contact closed pleurodesis” for patients with an unequivocal diagnosis of malignancy, a pleural effusion of more than half the size of the hemithorax, even if asymptomatic, and the expectation of a reasonably long survival period, using a vascular or pleural catheter to drain the fluid and introduce the sclerosing substance; depending on the chest x-ray, the catheter can be pulled out, left in situ to repeat the introduction of the sclerosing agent or, if this fails, to drain the fluid as often as necessary with a sterile syringe, ignoring the goal to achieve pleurodesis; the procedure is effective in over 90% of cases and non-expensive, can be done on an outpatient basis and does not require a chest tube nor a pleural drainage system. Present day consensus does not support parietal pleurectomy as an elective choice for these patients.


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