“Assessment of the Outcome of Povidone-Iodine Versus Bleomycin Pleurodesis in the Management of Malignant Pleural Effusion”

Introduction: Malignant pleural effusion is one of the most frequently encountered complications of certain malignancies with a well-documented higher rate of mortality. Pleurodesis is the best palliative treatment option in most of the time. The purpose of this study was to evaluate the efficacy of povidone iodine as an agent of chemical pleurodesis in comparison to bleomycin in the management of malignant pleural effusion. Methods: This cross-sectional study was carried out in the Department of Thoracic Surgery, National Institute of Diseases of the Chest and Hospital, from January 2021 to December 2021. A total of 120 patients, aged between 40 and 70 years, undergoing tube thoracostomy for malignant pleural effusion, were evaluated and divided into two groups based on the agent used for pleurodesis: the povidone iodine group (group A) and the bleomycin group (group B). Result: The mean age in Group A is 55.0 years (±8.03), while in Group B, it is slightly higher at 59.1 years (±8.77), however, the difference is not statistically significant (P = 0.085). More than 60% of patients were diagnosed through pleural fluid cytology, while over 30% had histological evidence. Both groups showed significant improvement in dyspnea and pain post-procedure, with no statistically significant differences in symptom relief across multiple follow-ups. Group A had a shorter hospital stay (10.70 ± 2.87 vs. 12.34 ± 2.56 days, P = 0.008) and a higher proportion of patients reporting no post-procedural complications (P = 0.001). However, treatment failure was slightly more common in Group A (13.3%) compared to Group B (6.7%); nonetheless, the overall success rates were comparable (76.7% vs. 80.0%, P = 0.836). During follow-up, chest X-rays revealed recurrence of effusion in 20% of patients in Group A and 13.4% in Group B, with no significant differences in effusion recurrence, while the mortality rates were 3.3% and 6.7% in Groups A and B, respectively, due to underlying malignancies. Conclusion: In our study, we found that both povidone-iodine and bleomycin are effective agents for pleurodesis in MPE, with similar clinical outcomes. Povidone-iodine offers the advantage of a shorter hospital stay and fewer post-procedure complaints, while bleomycin demonstrates a slightly lower failure rate. Given its lower cost and comparable efficacy, povidone-iodine may serve as a viable alternative for pleurodesis in resource-limited settings.