Efficacy and Safety of Povidone-iodine Pleurodesis in Malignant Pleural Effusions

Background: Malignant pleural effusion (MPE) is a known complication of advanced malignancy. It leads to recurrent pleural fluid accumulation and progressive dyspnea. Pleurodesis is one of the palliative treatment methods for preventing recurrent effusion. Previously, talc was the commonly used sclerosant; however, it is not commonly available in resource-constrained settings. Povidone-iodine is another sclerosant that is easily available and can be used as an alternative in these cases. The present study aimed to evaluate the efficacy and safety of povidone-iodine pleurodesis in patients with malignant pleural effusions. Material and Methods: This prospective interventional study included 40 patients with recurrent symptomatic malignant pleural effusion cases. Following complete drainage of pleural fluid and radiological confirmation of adequate lung expansion, pleurodesis was performed using 20 mL of 10% povidone-iodine diluted with 80 mL of normal saline and 10 mL of 2% lignocaine instilled through an intercostal drainage tube. Patients were followed up at one month and three months. The primary outcome was successful pleurodesis, defined as complete or partial response without the need for repeat pleural intervention. Secondary outcomes included improvement in dyspnea, duration of chest tube placement, hospital stay, radiological lung expansion, and procedure-related complications. Results: The mean age was 58.4 ± 12.3 years, with males comprising 60% of the study population. Lung carcinoma was the most common primary malignancy, accounting for 50%. The overall pleurodesis success rate was 90% at one month and 80% at three months. Complete response was achieved in 70% of patients at one month and 60% at three months, while partial response was observed in 20% of patients at both follow-up visits. The mean Visual Analogue Scale (VAS) dyspnea score improved significantly from 7.2 ± 1.5 before pleurodesis to 3.0 ± 1.2 at one month (p < 0.001). The mean time to chest tube removal was 4.5 ± 1.8 days, and the mean hospital stay was 6.5 ± 2.0 days. Chest radiograph expansion scores improved significantly from 2.8 ± 0.9 before pleurodesis to 8.5 ± 1.3 after the procedure (p < 0.001).  Conclusion: Povidone iodine pleurodesis appears to be an effective and safe method for the management of recurrent malignant pleural effusions. It provides good pleurodesis success rates, significant symptomatic relief, satisfactory lung re-expansion, and minimal serious complications. Given its low cost, easy availability, and favorable safety profile, povidone-iodine represents a practical alternative to conventional sclerosants, particularly in resource-constrained healthcare settings.

Keywords: Malignant pleural effusion, Povidone-iodine, Pleurodesis, Dyspnea, Pleural sclerosis, Palliative care.