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Disorders of the Pleura |

What Happens to the Pleural Space Affected by Malignant Effusion After Bedside Pleurodesis?

Pedro de Araujo, MD; Ricardo Terra, PhD; Thiago Santos, MD; Rodrigo Chate, MD; Antonio Fernando Paiva, MD; Paulo Pêgo-Fernades, PhD
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Thoracic Surgery, InCor, Sao Paulo, Brazil


Chest. 2015;148(4_MeetingAbstracts):443A. doi:10.1378/chest.2263957
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Abstract

SESSION TITLE: Disorders of the Pleura Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 28, 2015 at 01:30 PM - 02:30 PM

PURPOSE: To evaluate how evolves the pleural cavities of patients with good and poor lung expansion after drainage and submitted to bedside pleurodesis for recurrent malignant pleural effusion (RMPE).

METHODS: Prospective study including 131 patients. They underwent two chest CT scans, one right after the drainage (CT1) and another 30 days after pleurodesis (CT30). The evaluation of lung expansion was based on residual pleural volume on CT1 and the radiological evolution on the difference between the pleural volumes on CT30 and CT1 (Delta volume). The pleural volumes on CT1 were arbitrarily classified into small cavity (SC) (<500mL) and large cavity (LC) (≥500 mL). After that, the Delta volume was classified in unchanged (≥-268.77 and ≤254,49 mL), negative (<-268.77 mL) and positive (>254.49 mL) based on the average of the numerical variable and half of the standard deviation upwards and downwards. The clinical effectiveness (CE) was evaluated as the need for additional procedures to control symptoms.

RESULTS: We evaluated 87 patients. We found 54 patients (62.06%) in the SC group and 33 (37.93%) in the LC group. CE was 92.6% and 75.8% respectively. There was significant difference (p= 0.051), with an odds ratio of 4.00 (CI: 1.098 to 14.570). Among patients with SC, 27.77% progress with a significant accumulation of fluid, 66.66% did not show significant changes and 5.55% have decreased pleural volume. CE was 86.7%, 94.4% and 100% respectively with no significant difference (p= 0.552). Among patients with LC, 21.21% progress with an even greater pleural volume, 27.27% did not show significant changes and the majority (51.51%) evolves with a decrease. CE was 57.1%, 77.8% and 82.4% respectively with no significant difference (p= 0.418).

CONCLUSIONS: Almost two third of the patients with RMPE treated with pleurodesis had good lung expansion, while just over one-third had a bad one. Those with good expansion had 4 times higher chances of clinical success. Among poor lung expansion patients, more than half had significant reduction of pleural volume in 30 days, while a fifth had a significant accumulation.

CLINICAL IMPLICATIONS: Patients with good lung expansion have 4 times higher chances of clinical success. Even in the poor lung expansion cases, more than half evolves with significant reduction of pleural volume after pleurodesis.

DISCLOSURE: The following authors have nothing to disclose: Pedro de Araujo, Ricardo Terra, Thiago Santos, Rodrigo Chate, Antonio Fernando Paiva, Paulo Pêgo-Fernades

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