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Disorders of the Pleura |

Rapid Pleurodesis for Management of Malignant Pleural Effusions: A Single Center Experience

Rebecca Krochmal; Lonny Yarmus; David Feller-Kopman; Hans Lee
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University of Maryland, Baltimore, MD


Chest. 2014;146(4_MeetingAbstracts):431A. doi:10.1378/chest.1985370
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Abstract

SESSION TITLE: Malignant Pleural Disease Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PM

PURPOSE: Medical thoracoscopy with talc poudrage and tunneled pleural catheter (TPC) placement to achieve pleurodesis has previously been demonstrated to decrease hospital length of stay, duration of TPC use, dyspnea, and improve the performance status in patients with malignant pleural effusions. The purpose of this study is to evaluate our institutional experience with the previously described rapid pleurodesis protocol.

METHODS: A retrospective review of patient records following completion of the rapid pleurodesis protocol was performed between February 1, 2011 and January 31, 2014 at Johns Hopkins University. Electronic medical records were evaluated for patient demographics, procedural method, complications, and recurrence of pleural effusions.

RESULTS: 9 patients underwent medical thoracoscopy with concomitant pleurodesis of malignant pleural effusions. Insufflation of sclerosol was performed in 2 patients and dry powder talc in the remainder. A primary lung malignancy was present in 3 patients. 8 of 9 patients were undergoing concomitant chemotherapy. The median age was 60 years. On average, chest tubes were removed on post-operative day (POD) 2; median POD 1. Mean hospitalization was 4.22 +/- 4.79 days; median 2 days (POD 1). Tunneled pleural catheters were removed after a median of 7 days. 2 of 9 patients (22%) developed an infection related to the TPC, one of which maintained the indwelling TPC for 94 days due to non-expandable lung and insufficient pleurodesis. 2 different patients experienced recurrent pleural effusions after removal of the TPC, necessitating a repeat thoracentesis or TPC placement.

CONCLUSIONS: Similar to the previously published pilot study regarding a rapid pleurodesis method, our institutional review indicates that it is an effective mode of draining malignant pleural effusions and preventing recurrence with minimal complications and a brief hospitalization. For comparison, the experiences from other institutions would be beneficial.

CLINICAL IMPLICATIONS: Concomitant medical thoracoscopy with placement of a tunneled pleural catheter via a brief hospitalization appears to be an effective means of providing patients with symptomatic relief from malignant pleural effusions.

DISCLOSURE: The following authors have nothing to disclose: Rebecca Krochmal, Lonny Yarmus, David Feller-Kopman, Hans Lee

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