A Novel method for Pleurodesis: The Double Agent Pleurodesis

<bold>Background:</bold> Success rate of pleurodesis varies from 70- 90 % for various conditions such as pleural effusion and pneumothorax. We hypothesize that the sequential use of two agents for (Povidone Iodine followed by Talc) pleurodesis has an additive effect on positive outcomes with minimal post procedure complications. <bold>Methods:</bold> A sequential double agent pleurodesis was performed in a cohort of 218 patients over 10 years in our center. Ethical committee clearance was taken for the study. The pleurodesis was performed using 20 ml 10 % povidone iodine followed by 3-gram talc poudrage/ slurry. Immediate and long term (3 months) outcomes and complications were recorded. <bold>Results:</bold> 218 patients underwent pleurodesis over 10 years of which 190 patients were included for final analysis. 111 (58%) patients had malignant pleural effusion while 79 (42%) procedures were done for various benign conditions like recurrent spontaneous pneumothorax & transudative pleural effusions. The success rate with sequential double agent pleurodesis was 93 % overall (94% in malignant effusion and 92% for benign etiology). The success rate was higher when pleurodesis was performed during pleuroscopy (95%) as compared to chest drain/indwelling pleural catheter (IPC) pleurodesis (82%). Immediate post procedure complication was pain in majority of patients that lasted for a median of 13 hrs. (+/-8 hrs.). There were no significant complications such as ARDS in any patient. <bold>Conclusion:</bold> Sequential double agent pleurodesis is safe, well tolerated and effective procedure in patients with recurrent pneumothorax and malignant effusion. This technique has an additive benefit when compared to single agent pleurodesis in the existing literature.