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Iodopovidone Pleurodesis for Recurrent Pleural Effusions^*

^* From the Departments of Surgery (Drs. Olivares-Torres, Chávez-García, and Reyes-Escamilla), Pulmonary Diseases (Dr. Laniado-Laborín), and Anesthesia (Dr. Léon-Gastelum), Hospital General de Tijuana, Tijuana, Mexico; and the Department of Medicine (Dr. Light), Saint Thomas Hospital and the Center for Lung Research, Vanderbilt University, Nashville, TN.

Correspondence to: Rafael Laniado-Laborín MD, MPH, FCCP, PMB 953, 482 W San Ysidro Blvd, No. 2, San Ysidro, CA. 92173; e-mail: rafaellaniado{at}hotmail.com

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.

Key Words: iodopovidone • malignant pleural effusion • pleurodesis

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