Efficacy of povidone-iodine as an effective pleurodesing agent: an experience from a teaching hospital

The management of persistent malignant pleural effusion (MPE) or uremic pleural effusions requires the removal of pleural fluid and the prevention of recurrence through pleurodesis. Pleurodesis involves injecting a sclerosing agent into the pleura to encourage adhesion between the two layers, ultimately obliterating the pleural space. Povidone-iodine is a potential pleurodesing agent. This quasi-experimental study was conducted at the Department of Pulmonology, Shaikh Zayed Hospital, Federal Postgraduate Medical Institute, Lahore, Pakistan, over 1 year (March 2021 - March 2022). A total of 70 patients with MPE, uremic pleural effusions, and secondary spontaneous pneumothorax (SSP) were enrolled after meeting the inclusion criteria. The pleurodesis procedure involved administering a mixture of 20 mL of 10% povidone-iodine solution and 30 mL of normal saline through a chest tube, followed by clamping for 3 hours. Patients were scheduled for follow-up visits at 2, 4, 8, and 12 weeks. Data was analyzed using SPSS version 20.0. The average age of participants was 53.26 years (+13.71). Of the 70 patients, 39 (55.7%) were male and 31 (44.3%) were female. 62 patients (88.57%) had pleural effusion, and 8 patients (11.42%) had pneumothorax. The procedure was successful in 84.3% of patients, with varying success rates by diagnosis: MPE (81%), uremic pleural effusion (92%), and SSP (75%). Statistical analysis revealed significant positive effects of povidone-iodine on procedure outcomes (p=0.048) and effectiveness in preventing pleural effusion recurrence (p=0.028). This study indicates that 10% povidone-iodine can serve as a viable alternative to other pleurodesis agents, yielding standard-quality pleurodesis in 84.3% of patients. It is readily available, cost-effective, and has minimal adverse effects.