Medical Chemistry Assignment

By: Noor Al-Deen M. Al-Khanati

Chemical Pleurodesis
Pleurodesis is a procedure that obliterates the pleural
space in order to prevent recurrent pleural effusion or
recurrent pneumothorax. It is most commonly performed
by draining the effusion or intrapleural air and then
instilling a chemical irritant into the pleural space, which
induces inflammation and fibrosis. This is known as
chemical pleurodesis. Common questions about chemical
pleurodesis include:
• What are the indications for chemical pleurodesis?
• What are the contraindications?
• Which chemical irritant should be used?

Indications:
Chemical pleurodesis has been used to manage
malignant pleural effusions, refractory nonmalignant
pleural effusions, and pneumothorax.

Contraindications:
Pleurodesis will certainly fail if the lung cannot fully
expand (e.g. lung entrapment) because successful
pleurodesis requires contact of the visceral and parietal
pleura. Thus, chemical pleurodesis should not be
attempted in this setting.

Although there are no absolute contraindications to

chemical pleurodesis, success is less likely in malignant
pleural effusions when:
• Pleural fluid pH is lower than 7.20 or 7.30
• Glucose is less than 60 mg/dL
• Lactate dehydrogenase is >600 U/L

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Medical Chemistry Assignment
By: Noor Al-Deen M. Al-Khanati

Choice of Agent:
Numerous chemical irritants have been used to induce
pleurodesis including: talc, tetracycline, minocycline,
doxycycline, Corynebacterium parvum, fluorouracil,
methylprednisolone acetate, bleomycin, interferon beta,
mitomycin C, cisplatin, cytarabine, doxorubicin,
etoposide, and Streptococcus pyogenes A3 (OK-432).

In a systematic review, talc was the chemical agent that

most frequently resulted in complete success (no
recurrence of pleural fluid). Numerous additional studies
have confirmed that talc is the most effective agent for
pleurodesis, including a large meta-analysis. Taken
together, these studies indicate that successful
pleurodesis occurs in greater than 90 percent of patients
treated with talc.