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Correspondence |

Pleurodesis Practice in South and Central American Countries FREE TO VIEW

Evaldo Marchi, MD, FCCP; Francisco S. Vargas, MD; Bruna A. Madaloso, MD; Marcus V. Carvalho, MD; Lisete R. Teixeira, MD
Author and Funding Information

From the Heart Institute (Drs Marchi, Vargas, and Teixeira), University of São Paulo Medical School; and Medical College of Jundiai (Drs Marchi, Madaloso, and Carvalho).

Correspondence to: Evaldo Marchi, MD, FCCP, Pulmonary Division, Heart Institute (InCor), University of São Paulo Medical School and Medical College of Jundiai, São Paulo, Brazil, Alameda das Castanheiras, 196, Cd. Terras de São Carlos, Jundiaí 13.216-770 São Paulo, Brazil; e-mail: evmarchi@uol.com.br


Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestpubs.org/site/misc/reprints.xhtml).


© 2010 American College of Chest Physicians


Chest. 2010;137(3):739-740. doi:10.1378/chest.09-2171
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Malignant pleural effusion is a common complication of neoplastic diseases, and pleurodesis is still considered the most efficient alternative for the palliative control of recurrent effusions.1 Many studies have aimed to determine which is the best agent and technique for pleurodesis. Although previous expert panels have made recommendations for pleurodesis practice,2-4 a great variation in pleurodesis technique is still observed.5 We conducted a survey in countries of South and Central America to determine how specialists perform pleurodesis to control malignant pleural effusions.

The questionnaire was sent to approximately 2,500 professionals. Out of 915 respondents, 232 routinely performed the procedure, with an average of 25 pleurodesis procedures per year. The preference is to indicate pleurodesis only when pleural malignancy is confirmed, and scales of dyspnea and performance status are not routinely used to indicate the procedure. Nearly 75% of respondents in Brazil and Central America refer to perform pleurodesis only if the effusion is recurrent, preferably with 75% to 90% or 100% of pulmonary expansion. Talc via slurry, 2 to 5 g, is the most used agent, instilled by chest tube of intermediate size (16-28F). Thoracoscopy is used only in selected cases. Fever and chest pain are the most observed side effects, and 14% of the respondents observed cases of empyema postpleurodesis. The average survival time after pleurodesis is 6 to 12 months for all groups (Table 1).

Table Graphic Jump Location
Table 1 —Pleurodesis Practice, Demographics of Respondents
a 

P <.05 vs malignancy not confirmed.

b 

P <.05 vs use dyspnea as a criterion to indicate pleurodesis.

c 

P <.05 vs use performance status as a criterion to indicate pleurodesis.

d 

P <.05 vs indication in the first episode of effusion.

e 

P <.05 vs other percentages of expansion.

f 

P <.05 vs other agents.

g 

P <.05 vs other groups.

h 

P <.05 vs South and Central America.

i 

P <.05 vs chest drain of other sizes.

j 

P <.05 vs Brazil and Central America.

k 

P <.05 vs Brazil and South America.

l 

P <.05 vs South America.

m 

P <.001 vs Central America.

n 

P <.05 vs other time points.

In conclusion, there are considerable variations in respect to indication, way of accomplishment, and pleurodesis results among practitioners of South and Central American countries. We speculate that future cooperative studies involving specialists of different countries may be designed to determine the most efficient pleurodesis method.

Other contributions: We thank the Brazilian Sociedades Brasileira e Paulista de Pneumologia e Tisiologia (SBPT) and Latin America Asociación Latinoamericana del Tórax (ALAT-ULASTER) societies for their contribution.

Financial/nonfinancial disclosures: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Genofre EH, Marchi E, Vargas FS. Inflammation and clinical repercussions of pleurodesis induced by intrapleural talc administration. Clinics (Sao Paulo). 2007;625:627-634. [CrossRef] [PubMed]
 
Antony VB, Loddenkemper R, Astoul P, et al; American Thoracic Society American Thoracic Society Management of malignant pleural effusions. Am J Respir Crit Care Med. 2000;1625:1987-2001. [PubMed]
 
Antunes G, Neville E, Duffy J, Ali N. BTS guidelines for the management of malignant pleural effusions. Thorax. 2003;58Suppl:ii29-ii38. [CrossRef] [PubMed]
 
Teixeira LR, Pinto JA, Marchi E. Malignant pleural effusion. J Bras Pneumol. 2006;32Suppl:S182-S189. [PubMed]
 
Lee YC, Baumann MH, Maskell NA, et al. Pleurodesis practice for malignant pleural effusions in five English-speaking countries: survey of pulmonologists. Chest. 2003;1246:2229-2238. [CrossRef] [PubMed]
 

Figures

Tables

Table Graphic Jump Location
Table 1 —Pleurodesis Practice, Demographics of Respondents
a 

P <.05 vs malignancy not confirmed.

b 

P <.05 vs use dyspnea as a criterion to indicate pleurodesis.

c 

P <.05 vs use performance status as a criterion to indicate pleurodesis.

d 

P <.05 vs indication in the first episode of effusion.

e 

P <.05 vs other percentages of expansion.

f 

P <.05 vs other agents.

g 

P <.05 vs other groups.

h 

P <.05 vs South and Central America.

i 

P <.05 vs chest drain of other sizes.

j 

P <.05 vs Brazil and Central America.

k 

P <.05 vs Brazil and South America.

l 

P <.05 vs South America.

m 

P <.001 vs Central America.

n 

P <.05 vs other time points.

References

Genofre EH, Marchi E, Vargas FS. Inflammation and clinical repercussions of pleurodesis induced by intrapleural talc administration. Clinics (Sao Paulo). 2007;625:627-634. [CrossRef] [PubMed]
 
Antony VB, Loddenkemper R, Astoul P, et al; American Thoracic Society American Thoracic Society Management of malignant pleural effusions. Am J Respir Crit Care Med. 2000;1625:1987-2001. [PubMed]
 
Antunes G, Neville E, Duffy J, Ali N. BTS guidelines for the management of malignant pleural effusions. Thorax. 2003;58Suppl:ii29-ii38. [CrossRef] [PubMed]
 
Teixeira LR, Pinto JA, Marchi E. Malignant pleural effusion. J Bras Pneumol. 2006;32Suppl:S182-S189. [PubMed]
 
Lee YC, Baumann MH, Maskell NA, et al. Pleurodesis practice for malignant pleural effusions in five English-speaking countries: survey of pulmonologists. Chest. 2003;1246:2229-2238. [CrossRef] [PubMed]
 
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