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EDITORIAL
Year : 2021  |  Volume : 4  |  Issue : 3  |  Page : 93

Pleurodesis


Department of Respiratory Medicine, Apollo Hospitals Chennai, Tamil Nadu, India

Date of Submission20-Mar-2022
Date of Acceptance20-Mar-2022
Date of Web Publication12-May-2022

Correspondence Address:
R Narasimhan
Department of Respiratory Medicine, Apollo Hospitals Chennai, Greams Road, Chennai, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/japt.japt_4_22

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How to cite this article:
Narasimhan R. Pleurodesis. J Assoc Pulmonologist Tamilnadu 2021;4:93

How to cite this URL:
Narasimhan R. Pleurodesis. J Assoc Pulmonologist Tamilnadu [serial online] 2021 [cited 2022 May 16];4:93. Available from: http://www.japt.com/text.asp?2021/4/3/93/345083



Pleural effusion is a disturbing sign of either an infection or a malignant disease. It can also be a manifestation of connective tissue disease. This can be a disabling disease, more so if it is recurrent. Most of the pleural effusions are infectious nature either tuberculosis (TB) or malignant. In our country, TB being the most common, many patients get empirical TB treatment. This results in delay in diagnosis and management. With the newly available diagnostic modalities such as flexible thoracoscopy and rigid thoracoscopy, no patient should be started on empirical treatment. We as pulmonologists should not start any treatment for pleural effusion unless we have a tissue diagnosis.

An extension of the management of the pleural effusion is pleurodesis. Pleurodesis is a procedure done to obliterate the pleural space in recurrent pleural effusions and recurrent pneumothoraxes. Pleurodesis is commonly accomplished by draining the pleural fluid or intrapleural air followed by either a mechanical procedure or instilling a chemical irritant into the pleural space, which causes intense inflammation and fibrosis, subsequently leading to adhesions between the two pleural membranes. It is most commonly used in recurrent metastatic pleural effusions such as breast, ovarian, and lung malignancies.

Due to the limited life expectancy of these patients, this procedure at best can be called a palliative procedure but one of the best as it relieves dyspnea, cough, and debilitating respiratory symptoms. It can be done by chemical pleurodesis or by surgical means. By chemical pleurodesis, I mean an Intercostal drain has to be introduced and dry the pleural cavity, and after that, a chemical can be put inside the pleural cavity to induce an intense inflammatory reaction. The review article in this Journal describes the agents that can be used for pleurodesis with their merits and demerits. Mechanical and surgical pleurodesis is achieved with by doing a thoracoscopy, draining the pleural cavity, and putting the pleurodesing agent under vision.

Mechanical pleurodesis is mechanical abrasion (also termed dry abrasion) of the parietal pleura during thoracoscopy or thoracotomy or placement of a tunneled pleural catheter, which drains pleural fluid and may induce pleurodesis without instillation of a sclerosing agent. This procedure is useful for patients with massive pleural effusion with endobronchial occlusion where lung cannot expand.

One should also remember the entity failed pleurodesis. This happens when the tumor burden is too high, which causes decrease in mesothelial cells that causes a reduction in inflammatory response which is the key to success of the pleurodesis. The type of tumor also determines the response to pleurodesis; for example, mesotheliomas and metastatic carcinomas do not respond well as healthy mesothelial cells become deficient in them. The selection of the right patient for this is essential one and recognizing them is a challenge.

At last, this should not be considered the last resort, but a starting point for the therapy to follow as an asymptomatic patient will be willing to go through malignancy treatment much better psychologically than a patient who is puffing and gasping.






 

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