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Disorders of the Pleura |

The Impact of Pleural Catheter Position on the Success of Bedside Pleurodesis

Pedro de Araujo, MD; Ricardo Terra, PhD; Paulo Pêgo-Fernandes, PhD; Rodrigo Chate, MD
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Thoracic Surgery, InCor, Sao Paulo, SP, Brazil


Chest. 2014;146(4_MeetingAbstracts):452A. doi:10.1378/chest.1989229
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Abstract

SESSION TITLE: Pleural Disease

SESSION TYPE: Original Investigation Slide

PRESENTED ON: Wednesday, October 29, 2014 at 02:45 PM - 04:15 PM

PURPOSE: To investigate the impact of the pleural catheter position on the success of bedside pleurodesis, residual pleural space after effusion's drainage and acumulation of effusion pos pleurodesis in patientes with recurrent malignant pleural effusions (RMPEs).

METHODS: We retrospectively analysed 80 patients with RMPEs treated with pleurodesis (talc or silver nitrate slurry) at our hospital between June 2009 and September 2013. The position of the pleural catheter (14 Fr pigtail) was categorized as posterolateral (PL), anterior (A), fissural (F) and subpulmonary(SP) based on the location of the fenestrated portion of the cateter visualized at chest CT. Pleurodesis was considered successful when no additional pleural procedure was necessary. The pleural volume on CT was measured after drainage of the pleural effusion and one month after that. We used that data to calculated the residual pleural space after effusion drainage and the accumulation of effusion pos pleurodesis.

RESULTS: A total of 80 patients (61 female, 19 males, mean age 60.5 years) were included. The median Karnofsky Performance Status index was 60. In 45 patients we used talc and in 35 silver nitrate. The primary neoplasm was breast in 40 patients, lung in 20, ovary in 9, colon, prostate, kidney and indeterminate in 2 and thyroid, stomach and pancreas in 1. The position of the pleural catheter was posterolateral in 17 cases, anterior in 20, fissural in 10 and subpulmonary in 33. Successful pleurodesis was achieved in 71 patients (88.8%), with a similar distribution between groups (88.2 % in PL, 85% in A, 90% in F and 90.9% in SP, p=0.928). The mean initial pleural volume was 587.1ml (458.5-715.7), there was no significant difference between the groups (643.8 (288.5-999.2) in PL, 720.8 (405.8-1035.9) in A, 368 (164.8-571.2) in F and 555.4 (365.9-744.9) in SP, p=0.44). The mean difference between one month and initial pleural volumes was -104.5ml (-253.8-44.7), there was no significant difference between the groups (-61.6 (-315.5-192.1) in PL, -294.4 (-707.3-118.5) in A, 10.1 (-316.7-336.9) in F and -68.9 (-320.7-182.5) in SP, p=0.60).

CONCLUSIONS: In this study, the success of bedside pleurodesis, the residual pleural space after effusion drainage and the acumulation of effusion after pleurodesis were not affected by the position of the pleural catheter.

CLINICAL IMPLICATIONS: Regardless the pleural catheter position, bedside pleurodesis could be used to palliate the symptoms in patients with RMPEs.

DISCLOSURE: The following authors have nothing to disclose: Pedro de Araujo, Ricardo Terra, Paulo Pêgo-Fernandes, Rodrigo Chate

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