Chest
Original ResearchPulmonary ProceduresRapid Pleurodesis for Malignant Pleural Effusions: A Pilot Study
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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