0
Correspondence |

Rapid PleurodesisRapid Pleurodesis: An Outpatient Alternative: An Outpatient Alternative FREE TO VIEW

Erik Folch, MD; Jose Fernando Santacruz, MD
Author and Funding Information

From the Division of Thoracic Surgery and Interventional Pulmonology (Dr Folch), Beth Israel Deaconess Medical Center, Harvard Medical School; and the Department of Interventional Pulmonary Medicine (Dr Santacruz), Oncology Consultants, International Cancer Center.

Correspondence to: Erik Folch, MD, Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Harvard Medical School, 185 Pilgrim Rd, Deaconess 201, Boston, MA 02215; e-mail: efolch@bidmc.harvard.edu

TPC = tunneled pleural catheter.

aTime to office visit determined removal of TPC.

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.

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


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.

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.

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

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


Chest. 2011;140(6):1665-1666. doi:10.1378/chest.11-1681
Text Size: A A A
Published online

To the Editor:

We read with great interest in a recent issue of CHEST (June 2011) the report from Reddy et al,1 who describe a pilot study of rapid pleurodesis by combining medical thoracoscopy and talc poudrage with simultaneous tunneled pleural catheter (TPC) placement. In their report, they describe a success rate of 92%, with removal of the TPC at a median of 7.54 days. Furthermore, they have a median hospitalization time of 1.79 days, (mean 3.19). This is clearly a significant advance over the usual 5 to 7 days of hospitalization required during standard chemical pleurodesis.2,3

We used a similar protocol of simultaneous chemical pleurodesis with talc and TPC placement. This procedure evolved as patients with malignant pleural effusions have an average survival of a few weeks to months, so the need for expedient procedures that improve quality of life, minimize discomfort, and decrease the length of stay are of paramount importance.4,5 To date, we have treated eight cases with a few differences from those described by Reddy et al1 (Table 1).

Table Graphic Jump Location
Table 1 —Comparison of Rapid Pleurodesis Experiences

TPC = tunneled pleural catheter.

aTime to office visit determined removal of TPC.

Our standard procedure is a single-port thoracoscopy with parietal pleural biopsies, removal of pleural fluid, and instillation of 4 to 6 g of talc (Sclerosol). We did not leave a thoracostomy tube after the procedure. We placed the TPC on continuous suction for approximately 4 to 12 h, and patients were discharged home the same day of the procedure. We instructed the patients to drain the TPC every day for 5 days and then every other day until the next outpatient visit. Reaching similar results to those described by Reddy et al,1 we have had an excellent pleurodesis rate. The catheters were removed at the time of the follow-up visit in seven patients. Pain control was achieved in all cases with the use of oral opioid analgesics.

We agree with Reddy and colleagues1 that rapid pleurodesis with simultaneous chemical and TPC use should be subject to randomized controlled trials in an effort to change the “state of the art” in management of malignant pleural effusions. We hope our experience with a similar protocol and shorter length of stay will contribute in the accumulation of necessary data to support the feasibility, safety, and effectiveness of rapid pleurodesis.

Reddy C, Ernst A, Lamb C, Feller-Kopman D. Rapid pleurodesis for malignant pleural effusions: a pilot study. Chest. 2011;1396:1419-1423 [CrossRef] [PubMed]
 
Putnam JB Jr, Walsh GL, Swisher SG, et al. Outpatient management of malignant pleural effusion by a chronic indwelling pleural catheter. Ann Thorac Surg. 2000;692:369-375 [CrossRef] [PubMed]
 
Putnam JB Jr, Light RW, Rodriguez RM, et al. A randomized comparison of indwelling pleural catheter and doxycycline pleurodesis in the management of malignant pleural effusions. Cancer. 1999;8610:1992-1999 [CrossRef] [PubMed]
 
Antunes G, Neville E, Duffy J, Ali N. Pleural Diseases Group, Standards of Care Committee, British Thoracic Society Pleural Diseases Group, Standards of Care Committee, British Thoracic Society BTS guidelines for the management of malignant pleural effusions. Thorax. 2003;58suppl 2:ii29-ii38 [CrossRef] [PubMed]
 
Ernst A, Silvestri GA, Johnstone D. American College of Chest Physicians American College of Chest Physicians Interventional pulmonary procedures: guidelines from the American College of Chest Physicians. Chest. 2003;1235:1693-1717 [CrossRef] [PubMed]
 

Figures

Tables

Table Graphic Jump Location
Table 1 —Comparison of Rapid Pleurodesis Experiences

TPC = tunneled pleural catheter.

aTime to office visit determined removal of TPC.

References

Reddy C, Ernst A, Lamb C, Feller-Kopman D. Rapid pleurodesis for malignant pleural effusions: a pilot study. Chest. 2011;1396:1419-1423 [CrossRef] [PubMed]
 
Putnam JB Jr, Walsh GL, Swisher SG, et al. Outpatient management of malignant pleural effusion by a chronic indwelling pleural catheter. Ann Thorac Surg. 2000;692:369-375 [CrossRef] [PubMed]
 
Putnam JB Jr, Light RW, Rodriguez RM, et al. A randomized comparison of indwelling pleural catheter and doxycycline pleurodesis in the management of malignant pleural effusions. Cancer. 1999;8610:1992-1999 [CrossRef] [PubMed]
 
Antunes G, Neville E, Duffy J, Ali N. Pleural Diseases Group, Standards of Care Committee, British Thoracic Society Pleural Diseases Group, Standards of Care Committee, British Thoracic Society BTS guidelines for the management of malignant pleural effusions. Thorax. 2003;58suppl 2:ii29-ii38 [CrossRef] [PubMed]
 
Ernst A, Silvestri GA, Johnstone D. American College of Chest Physicians American College of Chest Physicians Interventional pulmonary procedures: guidelines from the American College of Chest Physicians. Chest. 2003;1235:1693-1717 [CrossRef] [PubMed]
 
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543