Iodopovidone Pleurodesis Research Articles

P29.01 Therapeutic Thoracentesis vs Iodopovidone Pleurodesis in Malignant Pleural Effusion Secondary to Lung Cancer–Randomizedtrial

P29.01 Therapeutic Thoracentesis vs Iodopovidone Pleurodesis in Malignant Pleural Effusion Secondary to Lung Cancer–Randomizedtrial

Iodopovidone pleurodesis for malignant pleural effusions: an updated systematic review and meta-analysis.

Chemical pleurodesis is an important option for palliation in malignant pleural effusion (MPE). To evaluate the status of iodopovidone for pleurodesis in MPE. We performed a systematic review of PubMed and EMBASE databases to identify studies evaluating the role of iodopovidone for pleurodesis in MPE. We calculated the pooled success rate of iodopovidone pleurodesis from observational studies and the risk ratio (RR) of successful pleurodesis (compared to other agents) from randomized controlled trials (RCTs). We pooled the data using the random-effects model. We also assessed the safety of iodopovidone. We included 26 studies (n = 1132, 15 observational, and 11 RCTs) in our review. The pooled success rate (95% confidence interval [CI]) from 15 observational studies (n = 648) was 90% (86-94). The efficacy rate of iodopovidone was similar with either tube thoracostomy or thoracoscopy. Eleven (n = 484) RCTs compared the efficacy of iodopovidone with other agents (especially bleomycin and talc). We found a similar success rate of iodopovidone compared to other agents with a pooled RR (95% CI) of 0.99 (0.91-1.08). The most frequent adverse event was chest pain. No hypo or hyperthyroidism, or visual disturbance was encountered in any study. There were no deaths attributed to iodopovidone use. Iodopovidone is a safe and effective agent for pleurodesis in the management of MPE. Further confirmation is required since the available evidence is limited by the low quality and small sample size of the included studies.

Video-assisted thoracoscopic iodopovidone pleurodesis for malignant pleural effusions in moderate to high-risk Colombian patients.

Introduction: In developing countries where talc may not be readily available, video-assisted thoracoscopic (VATS) iodopovidone pleurodesis offers an excellent alternative for the treatment of malignant pleural effusions (MPEs). Methods: This study analyzes a retrospective experience using VATS iodopovidone pleurodesis for malignant pleural effusions at a single cardiothoracic center in the capital of Colombia evaluating success according to LENT (Lactate, Eastern Cooperative Oncology Group-ECOG, Neutrophil-Lymphocyte ratio, Tumor type) scores. A total of 75 records of patients taken to VATS iodopovidone pleurodesis for MPEs were retrieved from our institutional database during a 5-year period from 2014-2019. Of these, 45 had complete clinical history data necessary to analyze both LENT scores and post-op follow-up imaging. Results: Of the 45 patients evaluated, 93.3% (42 patients) had either complete resolution of pleural effusions or partial resolution with an asymptomatic recovery within the first month post op. Chest pain was the most common postoperative complaint, which was present in 20% of patients. The mean postoperative ECOG score was 2±1.7. Patients with moderate to high-risk LENT scores had success rates of 96.7% and 92.3% respectively. Conclusion: Video-assisted thoracoscopic pleurodesis using Iodopovidone-iodine is an effective approach for MPEs. In developing countries where Iodopovidone iodine is readily available and affordable, patients may benefit from this agent with excellent results and minimal complications.

Ambulatory Iodopovidone Instillation Via Indwelling Pleural Catheters For Malignant Pleural Effusions.

Malignant pleural effusions' (MPEs) treatment goals focus on optimizing the quality of life and decreasing time spent in health care facilities in this patient population with limited life expectancy. Numerous pleural palliation options and combination of these exist and continue to undergo studies to identify safe, superior and ideally patient-centered care. We report a cohort of 13 patients with symptomatic MPE managed with iodopovidone intrapleural instillation via an indwelling pleural catheter (IPC) in the ambulatory setting. Successful complete pleurodesis was achieved in 10 of 13 (76.9%) patients at a median time of 5 days with IPC removal at a median of 16 days. Two patient obtained partial pleurodesis with IPC removal, 1 required IPC reinsertion due to symptom recurrence. Complications were limited to intraprocedural pain in 4 patients (31%). Iodopovidone pleurodesis via IPC may represent a safe, feasible, and effective ambulatory-based option for pleural palliation in MPE.

Comparison of additional minocycline versus iodopovidone pleurodesis during video-assisted thoracoscopic bleb resection for primary spontaneous pneumothorax: a propensity score-matched analysis.

The optimal chemical agent for additional pleurodesis during video-assisted thoracoscopic surgery (VATS) bleb resection in primary spontaneous pneumothorax (PSP) remains controversial. We compared the efficacy and safety of iodopovidone with those of minocycline for additional chemical pleurodesis during VATS bleb resection. Of 332 patients who underwent VATS bleb resection, 299 patients diagnosed with PSP were enrolled in this study. The patients were divided into two groups according to the chemical agents used for additional pleurodesis (iodopovidone versus minocycline). Propensity score matching was performed on the basis of the preoperative clinical parameters. Postoperative complications, chest tube indwelling time, postoperative hospital stay, and recurrence rate were compared between the two groups. The median duration of follow-up was 14 months (range, 1-94 months). After propensity score matching, 94 patients from the iodopovidone group and 94 patients from the minocycline group were matched. The perioperative outcomes, including fever, prolonged air-leak, prolonged-effusion, postoperative bed-side pleurodesis, and rehospitalization because of complications, were not significantly different between the two groups. However, the amount of drainage during the first two postoperative days, duration of chest tube indwelling, and duration of hospitalization were significantly shorter in the minocycline group (P<0.001). This study confirmed the safety of both minocycline and iodopovidone for additional pleurodesis. However, we carefully recommend minocycline over iodopovidone for pleurodesis because of faster postoperative recovery.

Safety Profile of the Use of Iodopovidone for Pleurodesis in Patients with Malignant Pleural Effusion

Background: Iodopovidone is an alternative agent used to promote pleurodesis in patients with malignant pleural effusion (MPE). However, safety is a concern, and many authors still reject its use. Objectives: Our main objective is to describe the occurrence of common and severe adverse events after pleurodesis with two different doses of iodopovidone in patients with MPE. Our secondary objective is to evaluate dose dependency, efficacy, quality of life, and systemic inflammation. Methods: We conducted a double-blind, randomized clinical trial including patients with recurrent MPE. Patients underwent chest tube insertion and were randomized into two groups according to the doses of iodopovidone: group 1 received 1% iodopovidone, and group 2 received 2% iodopovidone. During follow-up, adverse events, inflammatory markers, quality of life, and imaging exams were systematically evaluated and registered. Results: Sixty patients were analyzed (55 females, 5 males, median age 55.9 years). Overall, 227 adverse events possibly related to pleurodesis were registered, including 47 serious adverse events (in 34 patients). Pleuritic pain and hypertensive peaks were the most frequently observed serious adverse events (11 and 10 episodes, respectively). Grade 3/4 metabolic events such as hyponatremia and an increase in alkaline phosphatase, AST and ALT levels were also common. C-reactive protein (CRP) levels increased substantially and peaked 48 h after pleurodesis. No difference was observed between groups with regard to adverse events, CRP levels, efficacy, or quality of life. Conclusions: Adverse events after iodopovidone pleurodesis in patients with MPE are common and similar in the two doses studied.

IODOPOVIDONE PLEURODESIS FOR FIRST PRESENTATION OFPRIMARY SPONTANEOUS PNEUMOTHORAX

Background: The optimal initial management of primary spontaneous pneumothorax (PSP) remains controversial. Aim of the work: Evaluation of the safety and efficacy of intrapleural iodopovidone following intercostal tube drainage for initial treatment of PSP. Patients and Methods: Between June 2010 and June 2014,64 patients with documented first time primary spontaneous pneumothorax were enrolled in this study after obtaining informed consents. They were divided into two groups; Group 1 (control group) were 24 patients have PSP first time and managed by intercostal tube drain without pleurodesis, and group 2 were 40 patients have PSP first time and managed by intercostal tube drain with iodopovidone pleurodesis (20mL of 10% iodopovidone hydrochloride). Results: There was no significant difference between the two groups in terms of demographic data. Also, hospitalization rates and mean hospital stays had no significant difference between both groups. Patients in the iodopovidone group had higher doses of pethidine injection. After a mean follow-up of 9 months (range6-12 months), recurrence was noted in one patient (2.5%) of the iodopovidone group and 7 patients in the control group (29.2%). Conclusion: Intrapleural iodopovidone following intercostal tube drain is a simple, safe and convenient initial treatment for PSP thatreduce the rates of ipsilateral recurrence but associated with significant controllable chestpain.

Iodopovidone Pleurodesis for Isolated Pulmonary Langerhan’s Cell Histiocytosis in a Two Year Old Child

Isolated pulmonary involvement in Langerhans Cell Histiocytosis (LCH) is rare in childhood. The authors report a 2-y-old boy who presented with acute history of fever, cough and respiratory distress; later developed pneumothorax; whose CT thorax showed diffuse pulmonary cystic lucencies bilaterally. Lung biopsy confirmed pulmonary LCH with CD1a positivity. Recurrent spontaneous pneumothoraces are common in patients of pulmonary LCH; which necessitates rapid intervention. The authors share their experience of successfully using iodopovidone in pleurodesis for repeated pneumothorax episodes in this child with rare diagnosis of isolated pulmonary LCH.

Identification of the concentration of iodopovidone pleurodesis in rats for the maximal effectiveness

Background: This study aims to investigate the efficacy and safety of different doses of iodopovidone for pleurodesis and to evaluate the histopathological changes in thyroid tissue. Methods: Thirty-eight male Albino Wistar rats (260-320 g, 6-8 months old) included in this experimental study were randomly divided into four groups. Groups 1, 2, and 3 were given 2 mL/kg intrapleural iodopovidone at concentrations of 1%, 2%, 4%, respectively, while group 4 was administered intrapleural saline. The surfaces were graded by macroscopic and microscopic examination on Day 30 and thyroid tissues were histopathologically examined. Results: Iodopovidone at concentrations of 2% and 4% resulted in significantly more adhesions and inflammatory response. Four percent iodopovidone produced nonsignificant microscopic changes in the contralateral visceral pleural surface. No vacuolization in thyroid tissue showing hyperthyroidism was observed in the groups. Conclusion: We suggest that 2% iodopovidone is enough for an effective and safe pleurodesis and the concentration of iodopovidone may be raised to 4% in unsuccessful cases. However, as the study was conducted on rats, it still remains to be elucidated that the similar results can be achieved in human studies.

Effectiveness and safety of iodopovidone in an experimental pleurodesis model

OBJECTIVES:Chemical pleurodesis is an important therapeutic tool to control recurrent malignant pleural effusion. Among the various sclerosing agents, iodopovidone is considered effective and safe. However, in a recent study, ocular changes were described after iodopovidone was used in recurrent pneumothorax. The aim of the study was to evaluate the efficacy and morbidity of iodopovidone pleurodesis in an experimental model.METHODS:New Zealand rabbits were submitted to intrapleural injection of iodopovidone at concentrations of 2%, 4% and 10%. Biochemical (lactic dehydrogenase, proteins, triiodothyronine, free thyroxine, urea and creatinine) and immunological (Interleukin-8 [IL-8], VEGF and TGFβ) parameters were measured in the pleural fluid and blood. After 1, 3, 7, 14 and 28 days, groups of animals were euthanized, and macro- (pleura) and microscopic (pleura and retina) analyses were performed.RESULTS:An early pleural inflammatory response with low systemic repercussion was observed without corresponding changes in thyroid or renal function. The higher concentrations (4% and 10%) correlated with greater initial exudation, and maximum pleural thickening was observed after 28 days. No changes were observed in the retinal pigment epithelium of the rabbits.CONCLUSION:Iodopovidone is considered to be an effective and safe sclerosing agent in this animal model. However, its efficacy, tolerance and safety in humans should be further evaluated.

Thoracoscopic pleurodesis using iodopovidone versus pleural abrasions in management of recurrent pneumothorax

IntroductionSpontaneous pneumothorax is classified as either primary or secondary, recurrent pneumothorax may require further corrective and/or preventive measures such as pleurodesis. Aim of the workThe aim of this work was to compare the effectiveness of chemical pleurodesis using iodopovidone and mechanical pleurodesis by thoracoscopic pleural abrasions in management of recurrent spontaneous pneumothorax. Patients and methodsThirty patients with documented recurrent spontaneous pneumothorax were enrolled in this study after obtaining informed consents. The patients were divided into two groups each contains 15 patients. All patients were subjected to the following: full history taking, thorough clinical examination, laboratory investigations including prothrombin activity and INR, radiological evaluation and thoracoscopic intervention was done using rigid thoracoscope and videoscopy unit. ResultsThe success rate of iodopovidone pleurodesis in this study ranged from 88.7% after 1week to 92.3% after 1month. Whereas, the success rate of mechanical pleurodesis ranged from 73.3% after 1week to 90.9% after 1month. There was no significant statistical difference between the results of the follow up between the 2 groups after 1, 7, 30 and 90days. ConclusionChemical pleurodesis using iodopovidone was as effective as mechanical pleurodesis by thoracoscopic pleural abrasions in management of recurrent spontaneous pneumothorax.

Efficacy and safety of iodopovidone pleurodesis in malignant pleural effusions

Pleurodesis is one of the best methods of controlling malignant pleural effusions (MPE), a distressing complication of metastatic disease. In recent studies of a wide range of pleural diseases, iodopovidone was used as a sclerosing agent for pleurodesis and demonstrated good results with low morbidity. The aim of this study was to evaluate the efficacy and safety of iodopovidone pleurodesis in MPE. A retrospective analysis was performed on patients with MPE who underwent pleurodesis at our institution between 2005 and 2008. All patients underwent instillation of 20 mL of 10% iodopovidone, 80 mL of normal saline and 2 mg/kg of lidocaine through a chest tube, which was clamped for 2 h. The tube was removed when the daily output of fluid was <200 mL. Data on the requirement for additional pleural procedures, adverse events and survival were collected. Sixty-one pleurodesis procedures were performed in 54 patients. No procedure-related mortality was observed. Adverse events occurred after 11 (18%) pleurodesis procedures. The most frequent complication was mild thoracic pain that occurred immediately after 10 (16.4%) procedures, and one patient developed pleural empyema that was treated with drainage and antibiotics. A success rate of 98.4% was observed. Except for the patient who developed pleural empyema, none of the other patients had recurrences of pleural fluid or required additional pleural procedures during the follow-up period (mean of 5.6 months). Iodopovidone pleurodesis was successful and was associated with only a few minor complications. It appears to be a good option for the management of recurrent MPE.

Efficacy of Iodopovidone Pleurodesis and Comparison of Small-Bore Catheter Versus Large-Bore Chest Tube

To evaluate the efficacy of iodopovidone as an agent for pleurodesis in malignant pleural effusion (MPE) and to compare the efficacy of small-bore catheter (Pleuracan, Braun, Melsungen, Germany) and conventional large-bore chest tube in pleural fluid drainage and sclerotherapy. Patients with MPE were prospectively consecutively randomized into two groups between August 2004 and February 2007: pleurodesis via conventional (32F) chest tube (group 1) and small-bore catheter (group 2), both using iodopovidone. After 3 months' follow-up, response rates (complete or partial), complication rates, and duration of procedures within whole group, group 1, and group 2 were compared. Statistical analyses were performed by Mann-Whitney U, chi(2), and Fisher's exact test. Forty-three pleurodeses were performed in 41 patients. The response was complete in 26 (60.5%) and partial in 12 (27.9%), and the overall success rate was 88.4%. The response rate was not associated with the type of inserted tube (P = .750), pleural fluid pH (P = .290), or pleural fluid lactate dehydrogenase (P = .727). In group 1 (n = 20), 12 demonstrated complete and 6 demonstrated partial response, with a 90% success rate; success was 86.9% in group 2, with complete response in 14 and partial response in 6 patients. Success rates were similar in the two groups (P = 1.000). Of 43 procedures, complications were observed in 14 (32.5%), and complication rates were 35% and 30.4% in groups 1 and 2, respectively (P = .750). The most frequent complication was pain (16.2%), followed by fever, subcutaneous emphysema, dyspnea, and hypotension. Iodopovidone is an effective, inexpensive, safe, and easily available alternative in chemical pleurodesis in MPE. The success rates of pleurodesis were found to be similar regardless of the type of the tube inserted.

Iodopovidone pleurodesis does not effect thyroid function in normal adults

Iodopovidone is an effective, safe, cheap, and easily available agent for pleurodesis. On the other hand, topical applications of iodopovidone may cause thyroid dysfunction. The purpose of this retrospective study was to determine the effects of intrapleural administration of iodopovidone on thyroid function. Twelve patients have undergone iodopovidone pleurodesis so far. A mixture of 20 ml 10% iodopovidone and 80 ml 0.9% saline solution was administered into the pleural cavity through the chest tube. Thyroid hormone (TSH, TT4, TT3, FT4, FT3) levels were routinely measured just before pleurodesis, and at the 24th and 72nd h of pleurodesis. No statistically significant alteration in thyroid function was determined (P>0.05). We did not observe any signs or symptoms of hyper- or hypothyroidism in any patient. Nine patients had a complete response to pleurodesis (75%). One patient who had undergone iodopovidone pleurodesis suffered from a moderate degree of transient chest pain. In conclusion, iodopovidone pleurodesis is safe and does not cause any thyroid dysfunction in normal adults.

Efficacy and safety of iodopovidone pleurodesis through tube thoracostomy

To evaluate the efficacy and safety of iodopovidone as an agent for pleurodesis through tube thoracostomy in patients with recurrent pleural effusions and pneumothorax. This was a prospective study in which pleurodesis was performed with a solution of 20 mL 10% iodopovidone and 80 mL normal saline solution infused through a tube thoracostomy and left in the pleural cavity for 4 h. A total of 64 patients (34 men) with a mean (+/-SD) age of 47.1 +/- 15.4 years were included. There were 37 cases of pleural effusion and 27 of pneumothorax. A complete response (neither reaccumulation of fluid nor recurrence of pneumothorax) was obtained in 32 (86.5%) patients with pleural effusion and 25 (92.6%) patients with pneumothorax. A second procedure (i.e. repeated pleurodesis) was attempted successfully in four patients in the pleural effusion group. All patients experienced chest pain to a varying degree as recorded on a Visual Analogue Scale (median 50.5, range 10-95). Seven patients developed fever and one immunocompromised patient developed empyema following the procedure. There were no recurrences at a median follow up of 5 months (range 3-15 months) in the pleural effusion group, and 13 months (range 6-24 months) in the pneumothorax group. Iodopovidone can be used as an effective and safe agent for (chemical) pleurodesis (through tube thoracostomy), which is inexpensive and readily available.

Iodopovidone Pleurodesis for Recurrent Pleural Effusions

Chemical pleurodesis may be the best available treatment for recurrent and troublesome pleural effusions when the underlying cause cannot be corrected. A wide variety of pleural irritants have been used, but the search for the ideal agent for pleurodesis continues. The purpose of our study is to evaluate the efficacy and safety of iodopovidone as an agent for pleurodesis in patients with recurrent pleural effusion. Multicenter prospective study. The pleurodesis solution consisted of a mixture of 20 mL 10% iodopovidone and 80 mL normal saline solution. It was infused and left in the pleural cavity for 2 h. In 12 patients, pleurodesis was performed through a tube thoracostomy, and in the remaining 40 patients it was carried out at the end of diagnostic thoracoscopy. Fifty-two patients were included, with a mean (+/- SEM) age of 56.6 +/- 1.84 years. Eighty-five percent of the cases were related to a malignant neoplasm. A complete response, with no reaccumulation of fluid during follow-up, was obtained in 50 patients (96.1%). A second procedure was successful in the two remaining patients. Three patients (5.8%) experienced intense pleuritic pain and systemic hypotension after the instillation of the sclerosing agent. They recovered without incident. The mean length of follow-up was 13 +/- 1.46 months, with a median of 8.5 months. There were no 30-day postoperative deaths. Iodopovidone is an effective, safe, readily available, and inexpensive alternative to achieve chemical pleurodesis in cases of recurrent, incapacitating effusions, regardless of etiology.