Neumotórax espontáneo: sínfisis pleural con solución hidroalcohólica de povidona yodada

doi:10.1016/S0300-2896(03)75352-6

Archivos de Bronconeumología

Volume 39, Issue 4, 2003, Pages 171-174

https://doi.org/10.1016/S0300-2896(03)75352-6 Get rights and content

Objetivo

Analizar la eficacia de una solución hidroalcohólica de povidona yodada como agente químico sinfisante, en el tratamiento del neumotórax espontáneo

Material y método

Estudio descriptivo y retrospectivo de 81 pacientes con diagnóstico de neumotórax espontáneo, tratados mediante videotoracoscopia y pleurodesis química con una solución hidroalcohólica de povidona yodada, en el Servicio de Cirugía Torácica del Hospital de la Santa Creu i Sant Pau de Barcelona, desde enero de 1993 a diciembre de 1999

Resultados

Se trata de 81 pacientes, 59 varones (73%) y 22 mujeres (27%) con edades comprendidas entre los 14 y los 82 años (media de 33 años). El hemitórax afectado con mayor frecuencia fue el derecho, en 43 casos (53%)

Las principales indicaciones de tratamiento quirúrgico fueron: recidivas en 52 casos (64%) y fugas aéreas persistentes en 25 (31%)

Todos fueron tratados por videotoracoscopia, se realizó resección del parénquima pulmonar en 30 casos (37%) e instilación pleural de solución hidroalcohólica de povidona yodada como agente químico sinfisante en todos los casos. Durante el postoperatorio inmediato presentaron fugas aéreas 10 pacientes (12,3%), fiebre autolimitada 5 pacientes (6,1%) y hubo dos infecciones en los orificios de los drenajes (2,4%). Durante un período de seguimiento postoperatorio de 6 a 67 meses (media de 24 meses) hemos constatado 5 recidivas (6,1%)

Conclusiones

La solución hidroalcohólica de povidona yodada es un agente químico sinfisante de fácil aplicación por videotoracoscopia y de gran eficacia en el tratamiento del neumotórax espontáneo

Objective

To analyze the efficacy of an iodo-povidone hydroalcoholic solution for the chemical pleurodesis of spontaneous pneumothorax

Material And Method

A descriptive, retrospective study of 81 patients with spontaneous pneumothorax. The patients were treated by video-assisted thoracoscopy and chemical pleurodesis with an iodo-povidone hydroalcoholic solution at the thoracic surgery unit of Hospital de la Santa Creu i Sant Pau in Barcelona (Spain) between January 1993 and December 1999

Results

Eighty-one patients, 59 men (73%) and 22 women (27%), between 14 and 82 years old (mean age 33 years) were treated. Pneumothorax was most often on the right side (43 cases, 53%). The main indications for surgery were recurrence (52 cases, 64%) and persistent air leaks (25 cases, 31%). All were treated by video-assisted thoracoscopy, with resection of the pulmonary parenchyma in 30 cases (37%) and pleural instillation of the iodo-povidone hydroalcoholic solution as the irritant in all cases. Air leaks were observed during early postoperative recovery in 10 patients (12.3%), self-limited fever in 5 (6.1%) and infection of drainage openings in 2 (2.4%). During the postoperative follow-up period of 6 to 67 months (mean 24 months), 5 recurrences (6.1%) were seen

Conclusions

An iodo-povidone hydroalcoholic solution is easy to apply by video-assisted thoracoscopy and is highly effective for pleurodesis in cases of spontaneous pneumothorax

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Chemical pleurodesis with povidone-iodine for the management of pleuroperitoneal leak in peritoneal dialysis: A case report
2022, Nefrologia
Chemical pleurodesis for spontaneous pneumothorax
2013, Journal of the Formosan Medical Association
Citation Excerpt :
The optimal timing and choice of chemical pleurodesis for spontaneous pneumothorax, however, depends on the patient's condition, physician's experience, and availability of sclerosants. The indications, effects, and complications of common sclerosing agents are summarized in Table 1.11,22,27–30,34,40,41,43–49,53,55,58–61,66–69,72–77 Future studies should focus on the comparison of safety and efficacy of different sclerosing agents in specific clinical settings of spontaneous pneumothorax.
Pneumothorax is defined as the presence of air in the pleural cavity. Spontaneous pneumothorax, occurring without antecedent traumatic or iatrogenic cause, is sub-divided into primary and secondary. The severity of pneumothorax could be varied from asymptomatic to hemodynamically compromised. Optimal management of this benign disease has been a matter of debate. In addition to evacuating air from the pleural space by simple aspiration or chest tube drainage, the management of spontaneous pneumothorax also focused on ceasing air leakage and preventing recurrences by surgical intervention or chemical pleurodesis. Chemical pleurodesis is a procedure to achieve symphysis between the two layers of pleura by sclerosing agents. In the current practice guidelines, chemical pleurodesis is reserved for patients unable or unwilling to receive surgery. Recent researches have found that chemical pleurodesis is also safe and effective in preventing pneumothorax recurrence in patients with the first episode of spontaneous pneumothorax or after thoracoscopic surgery and treating persistent air leakage after thoracoscopic surgery. In this article we aimed at exploring the role of chemical pleurodesis for spontaneous pneumothorax, including ceasing air leakage and preventing recurrence. The indications, choice of sclerosants, safety, effects, and possible side effects or complications of chemical pleurodesis are also reviewed here.
Efficacy, morbidity and morbidity of surgical treatment of a primary spontaneous pneumothorax by videothorascopic talc pleurodesis
2011, Cirugia Espanola
Llamamos neumotórax espontáneo primario (NEP) a la presencia de aire en el espacio pleural sin causa o etiología conocida. La característica principal de esta enfermedad es su alta tendencia a la recidiva. Nuestro estudio tiene como objetivos: 1) conocer la eficacia del tratamiento quirúrgico mediante resección pulmonar por videotoracoscopia y pleurodesis con talco, 2) analizar las complicaciones derivadas del uso del talco.
Se revisa una serie de 130 casos de NEP tratados mediante videotoracoscopia con o sin resección parenquimatosa y pleurodesis con 3 g de talco libre de asbesto (STERITAL^®). Hemos recogido datos epidemiológicos, el método diagnóstico, la indicación quirúrgica, la mortalidad, la morbilidad general y la específica de la pleurodesis con talco, el número de recidivas y su tratamiento.
Nuestros pacientes tienen una edad media de 26,4 años, 84,3% son hombres y el 69% tiene hábito tabáquico. La indicación quirúrgica del NEP fue en el 74,4% por recidiva. Registramos una morbilidad del 7% que representan 9 casos, siendo la complicación más frecuente la fuga aérea. No registramos ninguna complicación específica por el uso del talco, tales como empiema, paquipleuritis o síndrome del distrés respiratorio del adulto (SDRA). Se realiza un seguimiento de 10,1 meses de media, constatándose 4 casos de recidiva que representan el 3%.
El tratamiento del NEP mediante videotoracoscopia y pleurodesis con talco tiene una alta eficacia, superior a otras técnicas empleadas para producir pleurodesis, una baja morbilidad general, mortalidad nula, y no registramos ninguna complicación específica debida al talco.
A primary spontaneous pneumothorax (PSP) is due to the presence of air in the pleural space and is of unknown cause or aetiology. The main characteristic of this condition is its high tendency to re-occur. This study has two objectives: 1) to determine the efficacy of lung resection surgery using a videothorascope and talc pleurodesis, 2) to analyse the complications originating from the use of talc.
A review was carried out on a series of 130 PSP cases treated using videothorascopy, with or without parenchymal resection, and pleurodesis with 3 g of asbestos-free talc (STERITAL^®). Epidemiological data were collected, including the diagnostic method, surgical indication, mortality, general morbidity, and the specific morbidity due to talc pleurodesis, the number of recurrences, and their treatment.
The patients had a mean age of 26.4 years, 84.3% were male, and 69% smoked. The surgical indication of the PSP was recurrence in 74.4% of cases. There was morbidity in 7% (9) cases, with the most frequent complication being an air leak. No specific complication, such as empyema, pachypleuritis or adult respiratory distress syndrome (ARDS, on the use of talc was recorded. The mean follow-up was 10.1 months, during which there was recurrence in 4 (3%) cases.
PSP treatment by videothorascopic talc pleurodesis is highly effective, superior to other techniques use to produce pleurodesis, has a low general morbidity, no mortality, and no specific complications due to the talc.
Usefulness of computed tomography in determining risk of recurrence after a first episode of primary spontaneous pneumothorax: Therapeutic implications
2007, Archivos de Bronconeumologia
The main cause of primary spontaneous pneumothorax is the rupture of subpleural blebs or bullae. The presence of bullae may also lead to an increased risk of recurrence. The best way to detect them is by means of computed tomography (CT). Our objective in the present study was to determine whether bullae detected by CT represent an increased risk of recurrence after a first episode of primary spontaneous pneumothorax. We also evaluated therapeutic implications.
We carried out a prospective study that included 55 patients (41 men and 14 women) with primary spontaneous pneumothorax. For all patients, the therapeutic recommendations of the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR) were followed. After resolution of the episode, a chest CT was performed and the presence, location, number, and size of bullae were evaluated. Subsequently, the number of recurrences in each group was evaluated.
The mean follow-up period was 30.7 months (95% confidence interval, 24-37 months). Twenty-six patients presented bullae, and 6 of these experienced recurrence. Of the 29 patients without bullae, 7 experienced recurrence. No association was found between the presence or absence of bullae and recurrence (P = .92). Bullae in the right lung led to more frequent recurrence of pneumothorax (P = .03). The number and size of the bullae had no significant influence on recurrence (P = .51).
The present study could not demonstrate that the presence, size, or number of bullae on CT scans has any influence on recurrence rate. We cannot recommend surgery after a first episode of primary spontaneous pneumothorax based on the presence of bullae on the CT scan.
La causa fundamental del neumotórax espontáneo primario es la rotura de bullas o blebs subpleurales. Estas bullas podrían también condicionar un mayor riesgo de recidiva. La mejor forma de detectarlas es mediante tomografía axial computarizada (TAC). Nos planteamos aquí si las bullas en la TAC suponen un riesgo mayor de recidivas tras un primer episodio de neumotórax espontáneo primario. Asimismo, se valoran las implicaciones terapéuticas.
Se trata de un estudio prospectivo en el que se incluyó a 55 pacientes (41 varones y 14 mujeres) con neumotórax espontáneo primario. En todos ellos se siguieron las recomendaciones terapéuticas de la Sociedad Española de Neumología y Cirugía Torácica (SEPAR). Tras la resolución del episodio se efectuó una TAC de tórax y se valoraron la presencia, la localización, el número y el tamaño de bullas. Posteriormente, se evaluó el número de recidivas en cada grupo.
El tiempo medio de seguimiento fue de 30,7 meses (intervalo de confianza del 95%, 24-37 meses). Presentaron bullas 26 pacientes, de los que en 6 hubo recidiva. De los 29 pacientes sin bullas, 7 presentaron recidiva. No se encontraron diferencias entre la presencia o ausencia de bullas y la recidiva (p = 0,92). Las bullas derechas recidivaron con mayor frecuencia (p = 0,03). El número y el tamaño de las bullas no tuvieron influencia significativa (p = 0,51).
El estudio no ha podido demostrar que la presencia de bullas en la TAC, su tamaño o su número influyan en el índice de recidivas. No se puede recomendar la cirugía tras un primer episodio de neumotórax espontáneo primario por presentar bullas en la TAC.
Iodopovidone: An inexpensive and effective agent for chemical pleurodesis
2007, Lung Cancer
Efficacy and safety of iodopovidone in chemical pleurodesis: A meta-analysis of observational studies
2006, Respiratory Medicine
The search for an ‘ideal’ agent for pleurodesis continues. Iodopovidone is a topical antiseptic and has been shown to be safe and effective in many studies. The aim of this study was to evaluate the efficacy and safety of iodopovidone as an agent for chemical pleurodesis. We performed a systematic review of all the observational trials which have used iodopovidone for chemical pleurodesis. Six studies including 265 patients who had undergone chemical pleurodesis with iodopovidone were included for this analysis. Iodopovidone was used for variety of indications, which included pleural effusion (157 patients), and pneumothorax (108 patients). Pleurodesis was performed through tube thoracostomy in 144 patients and through thoracoscopy in 121 patients. The success rate of pleurodesis varied from 64.2% to 100%, and summary success rate of all the studies was 90.6% (95% confidence intervals [CI], 86.4–93.8). The success rate was independent for the procedure (tube thoracostomy [126/144; 87.5%, 95% CI 80.9–92.4] or thoracoscopy [114/121; 94.2%, 95% CI 88.4–97.6]) used for performing pleurodesis or for the indication (pleural effusion [139/157; 88.5%, 95% CI 82.5–93.1] or pneumothorax [101/108; 93.5%, 95% CI 87.1–97.4]). The only significant complication reported was chest pain of varying degree. Systemic hypotension was reported in three patients in only one study. There were no deaths related to chemical pleurodesis with iodopovidone. Overall, this review supports the safety and efficacy of iodopovidone as an agent for chemical pleurodesis in cases of recurrent pleural effusions and pneumothoraces regardless of their etiology.

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Neumotórax espontáneo: sínfisis pleural con solución hidroalcohólica de povidona yodadaSpontaneous pneumothorax: pleurodesis with an iodo-povidone hydroalcoholic solution

Objetivo

Material y método

Resultados

Conclusiones

Objective

Material And Method

Results

Conclusions

Ann Thorac Surg

Ann Thorac Surg

Arch Bronconeumol

Chest

Ann Thorax Surg

Chest

Chest

Chest

J Thorac Cardiovasc Surg

Chest

Chest

J Thorac Cardiovasc Surg

Chest

Lancet

Ann Thorac Surg

Chest

Cir Esp

Neumotórax

Pleurodesis: state of the art

Eur Respir J