A new look at old agents for pleurodesis: nitrogen mustard, sodium hydroxide, and silver nitrate.

In this review we analyze the evolution of pleurodesis. In spite of the fact that this procedure started in the beginning of the 20th century, the ideal sclerosing agent is not yet known. Emphasis is placed on the current tendency toward minimally invasive procedures in which insertion of catheters is favored over surgical procedures such as placement of chest tubes or thoracoscopy. Among the sclerosing agents, talc is preferred throughout the world. However, the possible development of acute respiratory distress syndrome, which is sometimes fatal, caused the awakening of interest in other drugs. Nitrogen mustard induces pleurodesis but causes important side effects. Sodium hydroxide and silver nitrate are effective and may be used in humans beings.