Efficacy & safety of iodopovidone pleurodesis: a systematic review & meta-analysis

Ritesh Agarwal, Ajmal Khan, Ashutosh N Aggarwal, Dheeraj Gupta, Ritesh Agarwal, Ajmal Khan, Ashutosh N Aggarwal, Dheeraj Gupta

Abstract

Background & objectives: Chemical pleurodesis is an accepted therapy for patients with recurrent pleural effusions and pneumothorax. Iodopovidone has been shown to be safe and effective for chemical pleurodesis in several studies. The aim of this systematic review was to update a previously reported meta-analysis on the efficacy and safety of iodopovidone pleurodesis.

Methods: Two databases MEDLINE and EMBASE were searched for a period (1952-2010), and studies that have reported success rates with iodopovidone pleurodesis were selected. The proportions with 95 per cent confidence interval (CI) were calculated to assess the outcomes in the individual studies and the results were pooled using a random effects model.

Results: Thirteen eligible studies with 499 patients were included in the mata-analysis. The success rates varied from 70 to 100 per cent in different studies with the pooled success rate being 88.7 per cent (95% CI, 84.1 to 92.1). The success rate was not affected by the method (tube thoracostomy vs. thoracoscopy, 89.6 vs. 94.2%) or the indication of pleurodesis (pleural effusion vs. pneumothorax, 89.2 vs. 94.9%). The only significant complication reported was chest pain of varying degree. Systemic hypotension was reported in six patients across the studies. There were no deaths associated with iodopovidone pleurodesis. Statistical heterogeneity and publication bias were found.

Interpretation & conclusions: Iodopovidone may be considered a safe and effective agent for chemical pleurodesis in patients with pleural effusions and recurrent pneumothoraces.

Figures

Fig. 1
Fig. 1
Success rates of iodopovidone pleurodesis in patients with pleural effusions and pneumothoraces (random effects model). The success rate in the individual studies is represented by a vertical line (percentage) through which runs a horizontal line (95% confidence interval). The square represents the pooled data of the subgroups and the diamond at the bottom represents the pooled success rates across the subgroups.
Fig. 2
Fig. 2
Funnel plot comparing proportion versus the standard error of proportion for the outcome of iodopovidone pleurodesis. Open circles represent trials included in the meta-analysis. The line in the center indicates the summary proportion. The other lines represent the 95% confidence intervals. Asymmetry about the pooled proportion line is consistent with the presence of publication bias.

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