Pleurodesis

Pleurodesis is used as a possible treatment for complications from lung cancer, but it may also be recommended for other health conditions that cause difficulty breathing due to accumulation of fluid and/or collapse of lung. It’s a medical procedure designed to stop fluid or air from collecting in the pleural space—the space between the lung and chest wall. Your lung has visceral pleura (on the lung) and parietal pleura (on the chest wall).

Why is pleurodesis performed?

Pleurodesis may prevent two conditions: pleural effusion and pneumothorax.

• Pleural effusion is sometimes referred to as water in the lungs. It’s a buildup of fluid between the lung and chest wall.
• Pneumothorax is a collapsed lung due to air getting into the space between the lung and chest wall. Because the air cannot escape the chest wall, it accumulates and collapses the lung.

Both pleural effusion and pneumothorax may be caused by lung cancer or cancer that has metastasized (spread) into the lungs. Pleurodesis is performed to provide relief when patients are experiencing shortness of breath and discomfort.

How to prepare for the procedure

Ahead of the procedure, doctors typically provide instructions on what to do in advance. Guidelines may require patients to:

• Stop eating and drinking for a set number of hours before the procedure
• Notify doctors about all their medications, including blood thinners, aspirin, vitamins and other prescription and over-the-counter medicine
• Arrange a ride home from the hospital, since anesthetic and pain medicine may leave patients feeling tired, foggy and unable to drive

During the procedure

This procedure may be performed in one of several ways:

Chemical pleurodesis: The doctor makes a small incision in the chest and inserts a chest tube to remove any fluid from the pleural cavity or drains the air to allow for expansion of the lung. A substance is then inserted into the tube that causes the linings of the lung and chest wall to stick together. This can be performed at the patient's bedside or surgically. The procedure seals the space and limits further fluid buildup. Common drugs used for this include:

• Medical talc
• Doxycycline
• Chemotherapy drug such as bleomycin

Mechanical Pleurodesis: The pleura lining the chest wall is disrupted to create inflammation, allowing for visceral pleura to stick to the chest wall. This is performed surgically.

Pleurectomy: This type of procedure allows for pleurodesis. The pleura lining the chest wall is peeled off, exposing the entire underlying muscle and soft tissue of the chest wall. This allows the visceral pleura to stick to the chest wall and is performed surgically.

Surgical pleurodesis: The doctor makes a small incision and inserts a thoracoscope (a small tube with a light and camera) to drain fluid/air, and then then assesses the lung for full expansion. Through a separate incision, if full lung expansion is seen, chemical and/or mechanical pleurodesis is performed.

Patients typically require a few stitches to close up the incision site.

Potential complications and side effects

Although pleurodesis is considered safe, there are always risks with any medical procedure. Some complications associated with pleurodesis include:

• Chest pain and discomfort—Patients may experience chest pain after the procedure, but this is usually treated with pain medication.
• Fever—A day or two after pleurodesis, patients may notice they’re running a fever. Doctors may monitor this and provide medication if needed.
• Breathing problems—Breathlessness and difficulty breathing sometimes occur as a result of inflammation in the lung. With the help of oxygen, breathing typically returns to normal in a few days.
• Infection—Because a tube is inserted into the chest for pleurodesis, there’s a small risk of infection, which would be treated with antibiotics.

Following the procedure, patients are urged to call their doctor in case of any issues or 911 for serious concerns.

Recovery from pleurodesis

After pleurodesis, a patient will usually stay in the hospital for two nights with a chest tube inserted to ensure the lung stays inflated. This is an important way to ensure recovery is going as planned. Several follow-up appointments may be scheduled as well, including procedures such as X-rays to see whether treatment is working and discussions about any additional recommended treatments.