Eliana MuisM. Harun IskandarSubdivisi Pulmonologi / Bagian Ilmu Kedokteran Respirasi Fakultas Kedokteran Universitas Hasanuddin MakassarDefinition Pleurodesis is a medical procedure in which the pleural space is artificially obliterated Pleurodesis is a long-term symptomatic therapy (paliative treatment) and is expected to improve the patients quality of life, also daily activitiesIndication Pleurodesis is performed to prevent recurrence of pneumothorax Pleurodesis is performed to prevent recurrent pleural effusionContraindication No absolute contraindication for pleurodesis Contraindicated in negative pressure induced effusion (worsening symptoms during pleural evacuation) : Endobronchial obstruction Thick pleural peel with trapped lungMethods Chemical tetracycline, doxycycline, bleomycin, povidone iodine, slurry talc Surgical pleurectomy, thoracoscopic talc pleurodesis Radiotherapy radioactive gold, external radiationChemical Pleurodesis Chemicals such as bleomycin, tetracylcine, povidone iodine, or a slurry of talc can be introduced into the pleural space through a chest drain. The instilled chemicals cause irritation between the parietal and the visceral layers of the pleura which closes off the space between them and prevents further fluid from accumulating.Chemical Pleurodesis Povidone iodine is equally effective and safe as talc, and may be preferred because of easy availability and low cost. Chemical pleurodesis is a painful procedure, so patients are often premedicated with a sedative and analgesics. A local anesthetic may be instilled into the pleural space, or an epidural catheter may be placed for anesthesia.Malignant pleural effusionMassive pleural effusionSpecial considerations1. Are the symptoms (especially dyspnoea) directly related to the effusion? Thoracocentesis should relieve the patients symptoms of dyspnoea If dyspnoea is due to parenchymal involvement, thoracocentesiswill not reduce the symptomsSpecial considerations2. Is the effusion reccurent? This is commonly thought to be an important issue for consideration of pleurodesis Some clinicials suggested that pleurodesis be attempted sooner rather than later during the course of the diseaseSpecial considerations3. Is the lung re-expandable? The presence of a trapped lung should be suspected by the finding of very low pleural pressures as fluid is withdrawn during thoracocentesis It is recommended that measurement of pleural fluid pH be used as a first approach to assess multiple factors in evaluating a patient prior to pleurodesisSpecial considerations4. What is the life expectancy? Aggressive techniques, such as pleurodesis, should not be attempted in patients whose expected survival is short Certain clinical parameters (e.g Karnofsky index) can be of help in making decisions Pleural fluid glucose and pH determinations are very useful in selecting patients as candidates for pleurodesisStages of pleurodesis1. Installment of WSD2. PleurodesisIdentifikasi tempat dilakukan pemasangan WSD, aseptik dan lokal anastetikInsisi dg lebar 1-2 cm dan pelebaran klemHectingInsersi WSD (menggunakan trocar 22/24/28)Setelah cairan keluar dilakukan pengikatan dengan benang yang telah dipersiapkan sebelulmnya Bila produksi cairan pleura minimal (