Pleurodesis in the treatment of pneumothorax and pleural effusion.

Malignant pleural effusion and persistent and/or recurrent spontaneous pneumothorax are clinical entities requiring pleurodesis to avoid the accumulation of liquid and air, respectively. The objectives are to alleviate symptoms (dyspnea, pain and cough), decrease prolonged air leak, avoid recurrence and improve quality of life. Chemical pleurodesis utilizes chemical irritants. The most common of these is "talc" because of its efficiency and its success in lowering the rate of recurrence. Its main indication is in the palliative treatment of malignant pleural effusion. Other substances less frequently used because they are rarely used currently or under study are cytostatics, antibiotics, antiseptics and autologous blood. Surgical pleurodesis with mechanical abrasion by videothoracoscopy is indicated primarily in the treatment of spontaneous pneumothorax because it is highly efficient, easy to carry out, and has low morbidity when compared to pleurectomy. Using pleurodesis in benign effusion is highly controversial. Its principal indications are hepatic hydrothorax, chylothorax, and cardiac effusion that does not respond to medical treatment. Plasma determinations of systemic inflammatory markers and thoracic ultrasound studies can evaluate the efficacy of pleurodesis. We do not recommend the use of non-steroidal anti-inflammatory drugs in the postoperative period to avoid the possibility of interfering with hemostasis or the formation of adherences.