Procedures: Procedures: Pleura |

Efficacy of High Level Intrapleural Suction and Small Bore Drain in the Conservative Management of Multiloculated Pleural Effusions FREE TO VIEW

Francesco Leo, MD; Simone Furia, MD; Salima Madoui, MD; Serge Lacroix, MD; Jean Yves Delhoume, MD; Catherine Melin, PharmD; Ismet Noumri, MD
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Périgueux General Hospital, Périgueux, France

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;149(4_S):A441. doi:10.1016/j.chest.2016.02.459
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SESSION TITLE: Procedures: Pleura

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Saturday, April 16, 2016 at 11:45 AM - 12:45 PM

PURPOSE: In multiloculated pleural effusions (MPE), the use of intrapleural urokinase is generally combined to large bore drains and pleural suction to reduce the risk of drain malfunction. Due to technical reasons, standard devices effords only mild and uncontrolled negative pressure. We tested the hypothesis that an high level of continuous negative pressure obtained by a portable device permits the use of small bore chest drain in such a situation.

METHODS: The technique was standardized as follows: 1) the main collection was drained by a percutaneous 8 Ch drain, 2) the drain was connected to a portable suction device at a negative pressure of -70 cmH20 for 2 hours 3) 50000 UI of urokinase diluted into 100 ml of saline were injected and the drain was clamped for 2 hours twice a day for 5 days 4) a -70 cmH2O suction was mantained during the rest of the day and associated to two 45-minute session of physiotherapy. The main end-point of the study was the number of uneffective procedures, defined as MPE requiring surgical intervention within one month from the first treatment.

RESULTS: From January to August 2015, 10 consecutive patients (median age 71 years) were referred for a MPE due to pneumonia in 6 cases, empyema in 3 cases, infected hemothorax in 1 case. Median time from diagnosis to chest drain was 2 months. Two patients required 8 and 9 days of intrapleural treatment due to positive coltures on pleural fluid and persistent sistemic infection respectively. No patients required surgical intervention. In 9 cases, MPE disappeared within one month from the first treatment. A persistent collection was recorded in the hemothorax case, with negative coltures at the time of drain removal.

CONCLUSIONS: The use of high-negative suction pressures combined with intrapleural urokinase obtained a complete resolution of MPE in 90% of cases and no patient required surgery.

CLINICAL IMPLICATIONS: The proposed technique reduced patients discomfort by the use type of a small bore drain and can be routinely adopted in order to avoid surgery in case of successfull intrapleural treatment.

DISCLOSURE: The following authors have nothing to disclose: Francesco Leo, Simone Furia, Salima Madoui, Serge Lacroix, Jean Yves Delhoume, Catherine Melin, Ismet Noumri

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