ABSTRACT
Introducción: La pleurodesis química adhiere la pleura para prevenir colapsos pulmonares, el resultado benéfico del procedimiento como tratamiento se determina de acuerdo a si existe o no de derrame sintomático o neumotórax. Objetivo: Describir el porcentaje de derrame pleural o neumotórax espontáneo recidivante en sujetos mayores de 18 años que fueron llevados a pleurodesis con Yodopovidona en un Hospital Universitario de tercer de nivel en Bogotá. Métodos: Estudio descriptivo de serie de casos. Se estudiaron 30 pacientes con derrame pleural y neumotórax espontáneo que fueron llevados a pleurodesis utilizando diferentes técnicas entre enero de 2011 y Mayo de 2014 en un Hospital Universitario de tercer nivel en Bogotá. Se incluyeron en el estudio todos los pacientes mayores de 18 años quienes presentaban las patologías arriba descritas y a quienes se realizó pleurodesis química con Yodopovidona. Se excluyeron pacientes menores de 18 años y a quienes se realizó pleurodesis por otras técnicas o con otras sustancias. 14 pacientes cumplían los criterios de inclusión. Los datos fueron recolectados mediante la revisión de historias clínicas. El análisis estadístico se realizó mediante tablas de frecuencias, cálculo de medidas de tendencia central y porcentajes. Resultados: El promedio de edad fue de 61,85 años. El 57,14% de los pacientes presentaba derrame pleural maligno. Una respuesta completa a la pleurodesis en seguimiento al mes se presentó en 13 de los pacientes evaluados. Como único efecto adverso al procedimiento se reportó dolor. El promedio de estancia hospitalaria fue de 15 días. Conclusión: Basados en el presente estudio y otros se puede considerar que la Yodopovidona es una agente seguro, eficaz, de fácil consecución y bajo costo para la realización de pleurodesis química.
Introduction: Chemical pleurodesis adheres the pleura to prevent pulmonary collapses, the beneficial result of the procedure as a treatment is determined according to whether or not there is a symptomatic effusion or pneumothorax. Objective: To describe the percentage of pleural effusion or recurrent spontaneous pneumothorax in subjects older than 18 years who were taken to pleurodesis with iodopovidone in a University Hospital of third level in Bogotá. Methods: Descriptive study of case series. We studied 30 patients with pleural effusion and spontaneous pneumothorax who were taken to pleurodesis using different techniques between January 2011 and May 2014 in a third level University Hospital in Bogotá. All patients older than 18 years who presented the pathologies described above and who underwent chemical pleurodesis with Yodopovidona were included in the study. We excluded patients under 18 years and who underwent pleurodesis by other techniques or with other substances. 14 patients met the inclusión criteria. The data was collected by reviewing medical records. The statistical analysis was performed using frequency tables, calculation of central tendency measures and percentages. Results: The average age was 61,85 years. 57,14% of the patients presented malignant pleural effusion. A complete response to pleurodesis in a one-month follow-up was presented in 13 of the patients evaluated. Pain was reported as the only adverse effect. The average length of hospital stay was 15 days. Conclusion: Based on the present study and others, it can be considered that Yodopovidona is a safe, effective, easy to obtain and low cost agent for the performance of chemical pleurodesis.
ABSTRACT
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. .
Subject(s)
Animals , Rabbits , Pleural Effusion, Malignant/therapy , Pleurodesis/methods , Povidone-Iodine/administration & dosage , Sclerosing Solutions/administration & dosage , Cytokines/blood , Enzyme-Linked Immunosorbent Assay , Models, Animal , Pleura/drug effects , Povidone-Iodine/adverse effects , Retinal Pigment Epithelium/drug effects , Sclerosing Solutions/adverse effects , Time FactorsABSTRACT
Background & objectives: Chemical pleurodesis is an accepted therapy for patients with recurrent pleural effusions and pneumothorax. Iodopovidone has been shown to be safe and effective for chemical pleurodesis in several studies. The aim of this systematic review was to update a previously reported meta-analysis on the efficacy and safety of iodopovidone pleurodesis. Methods: Two databases MEDLINE and EMBASE were searched for a period (1952-2010), and studies that have reported success rates with iodopovidone pleurodesis were selected. The proportions with 95 per cent confidence interval (CI) were calculated to assess the outcomes in the individual studies and the results were pooled using a random effects model. Results: Thirteen eligible studies with 499 patients were included in the mata-analysis. The success rates varied from 70 to 100 per cent in different studies with the pooled success rate being 88.7 per cent (95% CI, 84.1 to 92.1). The success rate was not affected by the method (tube thoracostomy vs. thoracoscopy, 89.6 vs. 94.2%) or the indication of pleurodesis (pleural effusion vs. pneumothorax, 89.2 vs. 94.9%). The only significant complication reported was chest pain of varying degree. Systemic hypotension was reported in six patients across the studies. There were no deaths associated with iodopovidone pleurodesis. Statistical heterogeneity and publication bias were found. Interpretation & conclusions: Iodopovidone may be considered a safe and effective agent for chemical pleurodesis in patients with pleural effusions and recurrent pneumothoraces.