PURPOSE: Medical pleuroscopy has been shown to be a safe and effective procedure for the evaluation and management of exudative pleural effusions(Chest May 1975 67:5 573-576). Upon completion of the procedure, a chest tube is typically left in place overnight to facilitate pleural air and fluid evacuation; this commonly requires hospital admission. We sought to determine if a patient could be safely discharged home within six hours of performing medical pleuroscopy with pleural biopsies without requiring hospital admission.
METHODS: Twenty-two consecutive patients with varying causes of pleural disease resulting in chronic exudative effusions received local analgesia and monitored conscious sedation for single-port diagnostic pleuroscopy with pleural biopsies using a semi-rigid pleuroscope (Olympus, Japan) in an endoscopy suite. A single chest tube ranging from 14fr. to 28fr. was placed upon completion of each pleuroscopy. All 14fr. chest tubes were PleurX (Cardinal Health, Inc. Dublin, OH) catheters placed for malignant effusions. A chest radiograph was obtained at the first available opportunity upon completion of the chest tube placement and again approximately four hours later. All chest tubes were attached to 20cm of continuous suction via Oasis® Dry Suction Water Seal Drain (Atrium, Hudson, NH) for at least two hours, subsequently converted to water seal, and removed if lung expansion remained. Patients with PleurX catheters were disconnected from the water seal drain and were discharged home with their catheters in-vivo. All other patients had their chest tubes removed at the earliest opportunity after the second radiograph.
RESULTS: All twenty-two patients were safely discharged home within six hours of undergoing single-port diagnostic pleuroscopy with pleural biopsies. Twelve patients had malignant effusions, seven of which were discharged with PleurX catheters. The etiologies of the other effusions were acute infection (4), radiation pneumonitis (1), complex peripneumonic effusions (2), autoimmune (2), and atypical drug reaction (1). There were no postoperative bleeding complications or pneumothoraces seen neither prior to discharge nor in subsequent followup.
CONCLUSIONS: Patients that undergo medical pleuroscopy with pleural biopsies can be safely discharged the same day of the procedure.
CLINICAL IMPLICATIONS: Outpatient medical pleuroscopy is a safe, effective, and convenient procedure that can decrease health care resource utilization.
DISCLOSURE: The following authors have nothing to disclose: Michael Zgoda, Jaspal Singh
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