초록접수 현황
| 15F-143 | 구연 발표 |
Diluted Povidone-iodine for Chemical Pleurodesis in Patients with Secondary Spontaneous Pneumothorax─efficacy, Safety, and Risk Factors for Recurrence and Pulmonary Complication
Se Jin Oh, Jae-Sung Choi, Jeong Sang Lee, Hyeon Jong Moon, Yong Won Seong
Department of Thoracic and Cardiovascular Surgery, Seoul Municipal Boramae Hospital, Seoul National University Colleage of Medicine, Seoul, Republic of Korea
Background : There have been many reports of various types of chemical pleurodesis for pneumothorax or effusion from various causes. However, there have been not many reports regarding povidone-iodine pleurodesis for secondary pneumothorax. This study assessed the efficacy, safety, and risk factors for recurrence and pulmonary complications of povidone-iodine pleurodesis.
Methods : From Jan.2013 to Apr.2015, a total of 283 patients were admitted for treatment of pneumothoraces. Among these patients, 39 patients underwent povidone-iodine pleurodesis for secondary spontaneous pneumothorax. The mean age was 67.2 years, preoperative FEV1 in percent was 64.9%(22-100%). Male gender was 97.4%(38/39) and 97.4% of the underlying disease was diffuse bilateral homogenous emphysema. Five of these patients(12.8%) were admitted due to their ipsilateral recurrence without previous iodine pleurodesis. Single chest tube was placed in 92.3%(36/39) with 28Fr. size being the most common(74.4%). Six patients(15.4%) had comorbidities other than lung disease, and 8 patients(20.5%) revealed serum creatinine level more than 1.0mg/dL. Initial chest X-ray with pneumothorax revealed various types of intrapleural adhesion in 69.2%(27/39). First, single pleurodesis was performed using 100mL of diluted povidone-iodine in 1:4 ratio with normal saline. If additional pleurodeses were required, dilution ratio was increased to 2:3 and 1:1, respectively. Thoracic suction was applied continuously during the procedure with pressure of 20cmH2O.
Results : Sixty-nine percent(27/39) of the patients underwent more than two pleurodeses, and 94.9%(37/39) of the patients had their tubes adequately located. Povidone-iodine pleurodesis was successful in 76.9%(30/39) of the patients. The other 9 patients recurred, and needed closed thoracostomy again(10.3%), and/or underwent surgery(12.8%). All of the 39 patients suffered pleural pain during the procedures. There were 5 patients(12.8%) with failed pleural symphysis during the procedure, three of whom eventually underwent surgery. There were two(5.1%) patients with postprocedural pulmonary complications which were pneumonia and acute respiratory distress syndrome(ARDS), respectively. The patient with ARDS was the single case of mortality(2.6%). Failed pleural symphysis(p=0.007) was the only risk factor of recurrence from univariate analysis. Univariate analysis also revealed serum creatinine>1.0mg/dL(p=0.038), comorbidities other than pulmonary disease(p=0.020), failed pleural symphysis(p=0.013) to be risk factors for postprocedural pulmonary complications.
Conclusion : Diluted povidone-iodine pleurodesis in patients with secondary spontaneous pneumothorax can be a relatively safe and effective treatment alternative. Failed pleural symphysis was the only risk factor of recurrence. Increased serum creatinine, comorbidities other than pulmonary disease, and failed pleural symphysis were risk factors for pulmonary complications.
Methods : From Jan.2013 to Apr.2015, a total of 283 patients were admitted for treatment of pneumothoraces. Among these patients, 39 patients underwent povidone-iodine pleurodesis for secondary spontaneous pneumothorax. The mean age was 67.2 years, preoperative FEV1 in percent was 64.9%(22-100%). Male gender was 97.4%(38/39) and 97.4% of the underlying disease was diffuse bilateral homogenous emphysema. Five of these patients(12.8%) were admitted due to their ipsilateral recurrence without previous iodine pleurodesis. Single chest tube was placed in 92.3%(36/39) with 28Fr. size being the most common(74.4%). Six patients(15.4%) had comorbidities other than lung disease, and 8 patients(20.5%) revealed serum creatinine level more than 1.0mg/dL. Initial chest X-ray with pneumothorax revealed various types of intrapleural adhesion in 69.2%(27/39). First, single pleurodesis was performed using 100mL of diluted povidone-iodine in 1:4 ratio with normal saline. If additional pleurodeses were required, dilution ratio was increased to 2:3 and 1:1, respectively. Thoracic suction was applied continuously during the procedure with pressure of 20cmH2O.
Results : Sixty-nine percent(27/39) of the patients underwent more than two pleurodeses, and 94.9%(37/39) of the patients had their tubes adequately located. Povidone-iodine pleurodesis was successful in 76.9%(30/39) of the patients. The other 9 patients recurred, and needed closed thoracostomy again(10.3%), and/or underwent surgery(12.8%). All of the 39 patients suffered pleural pain during the procedures. There were 5 patients(12.8%) with failed pleural symphysis during the procedure, three of whom eventually underwent surgery. There were two(5.1%) patients with postprocedural pulmonary complications which were pneumonia and acute respiratory distress syndrome(ARDS), respectively. The patient with ARDS was the single case of mortality(2.6%). Failed pleural symphysis(p=0.007) was the only risk factor of recurrence from univariate analysis. Univariate analysis also revealed serum creatinine>1.0mg/dL(p=0.038), comorbidities other than pulmonary disease(p=0.020), failed pleural symphysis(p=0.013) to be risk factors for postprocedural pulmonary complications.
Conclusion : Diluted povidone-iodine pleurodesis in patients with secondary spontaneous pneumothorax can be a relatively safe and effective treatment alternative. Failed pleural symphysis was the only risk factor of recurrence. Increased serum creatinine, comorbidities other than pulmonary disease, and failed pleural symphysis were risk factors for pulmonary complications.
책임저자: Yong Won Seong
Department of Thoracic and Cardiovascular Surgery, Seoul Municipal Boramae Hospital, Seoul National University Colleage of Medicine, Seoul, Republic of Korea
연락처 : Yong Won Seong, Tel: 02-870-2294 , E-mail : arqjoker@gmail.com
