Pleurodesis: Agents and Techniques (Slurry, Poudrage, and IPC Pleurodesis)

Pleurodesis involves the adhesion of the parietal and visceral pleura, eliminating the pleural space and reducing pleural effusion or pneumothorax recurrence. The most common indication for pleurodesis is in the definitive management of malignant pleural effusion to prevent recurrence. In this chapter, we describe the agents and techniques commonly used for pleurodesis and their indications. Pleurodesis can be achieved using a sclerotic agent delivered via a chest tube, indwelling pleural catheter (IPC), or intraoperatively at medical thoracoscopy or surgery, including techniques such as mechanical irritation. The sclerosing agent with the highest evidence base for safety and efficacy is sterile talc, which likely reflects its widespread use. Pleurodesis success is similar when comparing talc slurry and talc poudrage. IPC insertion in patients with malignant pleural effusion may lead to reduced hospital days and re-intervention rate when compared with talc slurry via a chest tube but without advantages to quality of life. Surgical pleurodesis should be considered as a first-line modality for managing recurrent pneumothorax, particularly in high-risk occupations. Autologous blood patch pleurodesis is now recommended by international guidelines for the treatment of persistent air leak where surgery is not appropriate.