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Rebuttal From Drs Lee and Feller-KopmanRebuttal From Drs Lee and Feller-Kopman

Hans J. Lee, MD, FCCP; David J. Feller-Kopman, MD, FCCP
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From the Section of Interventional Pulmonology, Division Pulmonary and Critical Care, Johns Hopkins University.

CORRESPONDENCE TO: Hans J. Lee, MD, FCCP, The Johns Hopkins Hospital, 1800 Orleans St, Zayed Bldg 7125L, Baltimore, MD 21287; e-mail: hlee171@jhmi.edu


FINANCIAL/NONFINANCIAL DISCLOSURES: The authors have reported to CHEST the following conflicts: Dr Feller-Kopman has received consulting fees from CareFusion Inc. This editorial reflects Dr Feller-Kopman’s independent thoughts regarding the use of small-bore catheters in the treatment of pleural effusions. Dr Lee reports 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. See online for more details.


Chest. 2015;148(1):13-14. doi:10.1378/chest.15-0425
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Extract

We compliment Drs Gillespie and DeCamp1 on their insightful thoughts on the topic of small- vs large-bore catheters for the management of malignant pleural effusions. Although their criticism of the existing literature in support of small-bore catheters is fair, there has been no mention of citations supporting large-bore catheters. Assuming no difference in benefit between catheter sizes, which would we choose as a patient if both are equally effective? Our personal opinion would be the smaller catheter, which requires the smallest incision and is functional. Although there are no large, prospective, head-to-head comparative studies, there are data from large prospective trials using small-bore catheters for chemical pleurodesis (including talc).2,3 In one prospective study using 12F catheters, 52 patients had talc pleurodesis with no reports of failure of the procedure due to catheter occlusion.3 Additionally, Drs Gillespie and DeCamp1 make a distinction saying that tunneled pleural catheters should be considered large bore because most of the literature defines small bore as ≤ 14F. Although this may be true, it does not get to the intent of the differentiation between large and small, and we would argue that the 0.48-mm difference in the diameter between a 14F and 15.5F catheter is clinically irrelevant.

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