The use of Povidone iodine in the anticipation and management of prolonged post-operative air-leak

Background: Prolonged Air leak (PAL) is defined as air leak lasting beyond the fifth post-operative day. It is a very common situation after lung resections and is generally associated with a worse outcome with a more complicated postoperative course (prolonged hospitalization, increased costs …). Methods: It is a randomized, double-blind, prospective study .220 patients with a mean age of 61years, who underwent thoracic surgery in our department, were included. A spirometry was performed to measure the FEV1 (Forced Expiratory Volume). Each patient was subjected for the instillation of 25 ml of Povidone iodine in the chest tube. Results: Of these patients, 12% presented air leak in the first post-operative day. After injecting povidone iodine as a sclerosant agent, 61.5% of these patients didn’t present any air leak (AL) in the 2 first post-operative days (61.5% versus 38.5%). It has also reduced the chest drain time (3 days versus 7.5 days). Many risk factors of PAL may influence the chest drain time such us : the low FEV1 (13 days versus 6 days), the kind of the surgical procedure performed (3.5 days after a surgery of a pneumothorax versus 7 days after lobectomy or bilobectomy with p= 0.02), the performance of upper lobectomy (18 days versus 8 days), the presence of pleural adhesions (5 days versus 3 days) and the number of chest tubes used (2 days using one chest tube versus 5 days using 2 or 3 chest tubes). Conclusion: Prolonged air leak is a serious postoperative complication after lung resections. In this study, Chemical pleurodesis using Povidone iodine as a sclerosant agent has been proved to be an effective and safe method for early management of this complication.