When is pleurodesis (pleural sclerosis) indicated in the treatment of pleural effusion (fluid on the lungs)?

Updated: Dec 28, 2018
  • Author: Kamran Boka, MD, MS; Chief Editor: Guy W Soo Hoo, MD, MPH  more...
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Answer

Patients with poor performance status (Karnofsky score < 70) and a life expectancy of less than 3 months should not be treated with pleurodesis, and can be treated with repeated outpatient thoracentesis as needed to palliate symptoms. [52] Unfortunately, pleural effusions can reaccumulate rapidly, and the risk of complications increases with repeated drainage.

Patients with lung entrapment from malignant effusions are not good candidates for repeated thoracentesis, because they may not relieve dyspnea in such patients, nor for pleurodesis, as the visceral and parietal pleural surfaces cannot stay apposed to allow the bridging fibrosis. The best treatment for effusions in such patients may be the insertion of an indwelling tunneled catheter, which allows patients to remove pleural fluid as needed at home. [53]


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