Pleurodesis

Abstract

Pleurodesis is defined as the symphysis of the parietal and visceral pleura. This is obtained by the mechanical or chemical induction of pleural inflammation. The most frequent indication for pleurodesis is malignant pleural effusion, followed by pneumothorax. The best available agent for chemical pleurodesis is talc powder. Intrapleural instillation of talc is safe ifgraded (large particle size) talc is used. Talc poudrage during thoracoscopy is supposed to produce a better result than talc slurry instilled through a chest tube. The advantage of talc poudrage is that the procedure can be combined with a diagnostic thoracoscopy and complete removalof all residual pleural fluid. For optimal results, anti-inflammatory drugs (NSAIDS and corticosteroids) should be avoided in the period of talc pleurodesis. The best results are obtained early in the disease, when the performance status is good and the patient has not developed a trapped lung.