Case Series: Iodopovidone Pleurodesis for Pediatric Spontaneous Pneumothorax

Background: Treatment of pediatric primary spontaneous pneumothorax (PSP) with tube thoracostomy alone has been associated with a 66% recurrence rate at our institution. We sought to decrease recurrence with a simple and cost-effective intervention: iodopovidone chemical pleurodesis. An institutional protocol was developed and implemented, addressing indications, informed consent, iodopovidone (povidone iodine) concentration, mixture with lidocaine, method of administration, dwell time, pain control, and safety measures. Iodopovidone pleurodesis was offered to children who would have otherwise been treated with tube thoracostomy alone on our existing PSP protocol. Case Presentation: Three patients aged 15-17 years, including one with shellfish allergy, were admitted for treatment of PSP. After informed consent was obtained, all patients underwent iodopovidone chemical pleurodesis under our institutional protocol. In all cases, pain control was excellent with 0-3 doses of post-procedure opioid administered. Air leak was absent on post-procedure day 1 in all patients. All patients were discharged on post-procedure day 3 or 4 in excellent condition, and remain free of pneumothorax recurrence at 4-9 months. Discussion: Pediatric PSP has a high rate of recurrence both locally and in the published literature. Ideal treatment would accomplish a rapid and durable resolution of PSP, with minimal healthcare utilization and costs, and minimal recurrence risk. Iodopovidone is cost-effective, readily available, easy to handle, antibacterial, safe, and effective for pleurodesis. Our initial experience demonstrates this approach is feasible in the pediatric population. Conclusion: Iodopovidone pleurodesis is a simple, cost-effective, and well-tolerated treatment for PSP. In patients receiving tube thoracostomy for PSP, iodopovidone pleurodesis may reduce recurrence and need for operative intervention.