Chemical Pleurodesis

• accepted palliative therapy for patients with recurrent, symptomatic malignant pleural effusions.
• Not all chemical agents have undergone direct comparison under similar conditions
• Talc was the most effective agent (success rate of 93%). The most commonly reported adverse effects were pain and fever
• In a systematic review, talc was the chemical agent that most frequently resulted in complete success (no recurrence of pleural fluid)
• based on the more recent guidelines (BTS Pleural Disease Guideline 2010) only talc is recommended as part of the therapy

Indication

• have significant symptoms that are relieved when pleural fluid is evacuated
• evidence of complete re-expansion of the lung without evidence of bronchial obstruction or fibrotic trapped lung

Doxycycline

• success rate of up to 80–85% in carefully selected patients
• Most studies have recommended the utilization of 500 mg of doxycycline mixed with 50–100 cm3 of sterile saline
• narcotic analgesic and/or conscious sedation is often recommended as pain is the most common complication

Administration

• If is receiving corticosteroid therapy, the drug should be stopped or the dose reduced if possible because of concerns of decreased efficacy of pleurodesis
• Most commonly, pleurodesis is performed via a standard tube thoracostomy
• intravenous narcotic analgesics and/or sedation are often recommended because of the pain associated with many sclerosing agents
• sclerosing agent of choice is then added to the chest tube, typically in a solution of 50–100 cm3 of sterile saline
• chest tube is then clamped for 1 h, without rotation of the patient being required. 
• The chest tube is then subsequently reconnected to 20 cm H2O suction. It is then recommended that suction be applied to the chest tube until the 24-h output from the chest tube is less than 150 cm3

References:

1. www.uptodate.com
2. https://www.brit-thoracic.org.uk/document-library/clinical-information/pleural-disease/pleural-disease-guidelines-2010/pleural-disease-guideline-quick-reference-guide/
3. https://www.thoracic.org/statements/resources/pleural-disease/1987