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Original Research: PULMONARY PROCEDURES |

Rapid Pleurodesis for Malignant Pleural Effusions: A Pilot Study

Chakravarthy Reddy, MD; Armin Ernst, MD, FCCP; Carla Lamb, MD, FCCP; David Feller-Kopman, MD, FCCP
Author and Funding Information

From the University of Utah Health Sciences Center (Dr Reddy), Salt Lake City, UT; St. Elizabeth Medical Center (Dr Ernst), Brighton, MA; Lahey Clinic (Dr Lamb), Burlington, MA; and Johns Hopkins University (Dr Feller-Kopman), Baltimore, MD.

Correspondence to: David Feller-Kopman, MD, FCCP, Bronchoscopy and Interventional Pulmonology, Johns Hopkins University, 1830 E Monument St, 5th Floor, Baltimore, MD 21205; e-mail: dfellerk@jhmi.edu


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


© 2011 American College of Chest Physicians


Chest. 2011;139(6):1419-1423. doi:10.1378/chest.10-1868
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Published online

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.

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