Abstract
Background: To determine the efficacy, feasibility, and safety of high-dose povidone-iodine for pleurodesis administered via pleuroscopy in patients with malignant pleural effusion (MPE).
Materials and Methods: We performed a retrospective analysis of patients who underwent medical Pleuroscopy for pleural effusions of unknown etiology between January 2022 and January 2024. In patients with confirmed MPE, pleurodesis was performed using 60 mL of 10% povidone-iodine mixed with lidocaine and sterile saline. Outcomes measured included the success of pleurodesis, duration of indwelling pleural catheter (IPC) placement, length of hospital stay, complications, and mortality. The study received institutional review board approval, and due to its retrospective nature, the requirement for informed consent was waived.
Results: Out of 58 patients who underwent pleuroscopy, 31 (53.4%) had MPE confirmed by pleural biopsy. The most common histologic subtype was adenocarcinoma (39%), followed by non-small cell carcinoma (NSCLC) (26%). Pleurodesis was attempted in 30 cases and achieved a 96.7% success rate, with only one failure, observed in a patient with lung cancer pleural metastases. The highest success rates of pleurodesis were seen in adenocarcinomas (39%) and NSCLC (26%). The median duration of IPC placement was 20 days, with a reduction in drainage observed within one week in most patients. The median follow-up period was 12 months, with an all-cause mortality rate of 42% at the end of that period. Minor complications such as subcutaneous emphysema (16%) and post-procedure pain (16%) were observed without significant morbidity.
Conclusions: High-dose povidone-iodine pleurodesis via pleuroscopy is a safe and highly effective option for managing MPE. It offers a cost-effective alternative to talc, with comparable efficacy and minimal adverse effects. These findings are particularly relevant in resource-limited settings and warrant further prospective, controlled studies for incorporation into future guidelines.
