Chest
Volume 139, Issue 6, June 2011, Pages 1419-1423
Journal home page for Chest

Original Research
Pulmonary Procedures
Rapid Pleurodesis for Malignant Pleural Effusions: A Pilot Study

https://doi.org/10.1378/chest.10-1868Get rights and content

Background

Malignant pleural effusions (MPEs) affect > 150,000 people each year in the United States. Current palliative options include pleurodesis and placement of an indwelling catheter, each with its own associated benefits. This study was conducted to determine the safety, efficacy, and feasibility of a rapid pleurodesis protocol by combining medical thoracoscopy with talc pleurodesis and simultaneous placement of a tunneled pleural catheter (TPC) in patients with symptomatic MPE.

Methods

Patients with recurrent, symptomatic MPEs underwent medical thoracoscopy with placement of a TPC and talc poudrage. The TPC was drained per protocol until the output was < 150 mL/d on two consecutive drainage attempts and then removed. Patients were followed for up to 6 months.

Results

Between October 2005 and September 2009, 30 patients underwent the procedure. The median duration of hospitalization following the procedure was 1.79 days. All patients showed an improvement in dyspnea and quality of life. Pleurodesis was successful in 92% of patients, and the TPC was removed at a median of 7.54 days. Complications included fever (two patients), the need for TPC replacement (one patient), and empyema (one patient).

Conclusion

Rapid pleurodesis can be achieved safely by combining medical thoracoscopy and talc poudrage with simultaneous TPC placement. Both hospital length of stay and duration of TPC use can be reduced significantly as compared with historical controls of either procedure alone. Future randomized trials are needed to confirm these results.

Section snippets

Patients

This protocol was approved by the institutional review boards at Beth Israel Deaconess Medical Center, Boston, Massachusetts (IRB 2005P-000234), and Lahey Clinic, Burlington, Massachusetts (IRB LDCI 2006-015). Patients referred for management of MPE between October 2005 and September 2009 were considered for the procedure. All patients underwent a thoracentesis to confirm postprocedure relief of dyspnea and full lung reexpansion. Reexpansion of the lung was confirmed in all patients, based on

Results

Thirty-one patients met the inclusion criteria, consented, and underwent the combined thoracoscopy with talc pleurodesis and TPC placement. One patient changed his mind following the procedure and requested the tunneled catheter be removed, and he was excluded from final analysis. Table 1 and Figure 2 outline the patient demographics and distribution. Two-thirds of the patients were women (n = 20) and the mean age was 65.2 years. The primary tumor originated in the lung or the breast in

Discussion

The goals of pleural palliation should be to achieve an improvement in dyspnea while simultaneously minimizing contact with the medical system, allowing the patient to achieve as close to a “normal” quality of life as possible. Reducing hospital length of stay should be an important goal in the care of these patients, given their limited life expectancy. Current guidelines recommend chemical pleurodesis in all patients who present with recurrent symptomatic MPE.1, 2, 8 Although there is no

Conclusions

In summary, we have shown that a rapid pleurodesis protocol using both TP and the TPC is safe and efficacious and results in significant improvements in dyspnea and performance status in the patient population. Randomized trials are needed to compare this protocol with standard talc pleurodesis to draw firm conclusions about safety, efficacy, and cost.

Acknowledgments

Author contributions: Dr Reddy: contributed to the study concept and design, analysis and interpretation of the data, and drafting of the manuscript.

Dr Ernst: contributed to the study concept and design, analysis and interpretation of the data, and drafting of the manuscript.

Dr Lamb: contributed to the study concept and design, analysis and interpretation of the data, and drafting of the manuscript.

Dr Feller-Kopman: contributed to the study concept and design, analysis and interpretation of the

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