DIGITAL DRAINAGE DEVICES IMPROVE EFFICACY OF CONSERVATIVE MANAGEMENT IN MULTILOCULATED PLEURAL EFFUSIONS

Abstract

SESSION TITLE: Disorders of the Pleura Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: In conservative management of multiloculated pleural effusions (MPE), intrapleural administration of fibrinolytic agents is the keypoint of treatment, avoiding surgery in 70% of cases. The type of suction applied to the chest drain is considered of little importance. We tested the hypothesis that increasing pleural suction by the use of a digital device may further reduce the number of patients requiring surgical debridement. METHODS: Since March 2013, all patients admitted for MPE were drained, 50000 UI of urokinase diluted in 100 ml of saline were injected 3 times a day for 5 days and then CT scan was repeated. In the first period (March 2013-January 2014, group A), a -15 cmH2O suction was mantained by a standard collection system (Aquaseal, Covidien, USA). In the second period of the series (February 2015-April 2020, group B), a -70 cmH2O suction was mantained by a digital chest drain device (Thopaz, Medela, Suisse). The main end-point of the study was the comparaison of the 2 groups in terms of failure of conservative management, defined as the need of surgical intervention within one month from the first drainage. RESULTS: From March 2013 to April 2020, 95 consecutive patients were admitted with diagnosis of MPE, with a median time from symptoms onset to drainage of 1 month. During the first period, (group A), 6 out of 24 patients (25%) required surgical debridement by VATS (2) or thoracotomy (4) for the persistence of infection signs and/or a large pleural collection. In the second period (group B), 2 our of 71 patients (2.8%) needed thoracotomy, due to the presence of concomitant lung abscess and extensive air leak. The difference in terms of conservative management failure between the 2 groups was statistically significant (p=0.003). At univariate analysis, no other difference in terms of clinical variables was detected between group A and B. CONCLUSIONS: Results from this retrospective study suggest that increasing intrapleural negative pressure by the use of a digital drain system improves results of MPE conservative management, limiting the need of surgery to patients with concomitant, complicated lung abscess. CLINICAL IMPLICATIONS: The strategy of increasing intrapleural negative pressure in MPE can improve efficacy of intrapleural fibrinolysis and reduce the need of surgical debridement or decortication. DISCLOSURES: No relevant relationships by Dan Angelescu, source=Web Response No relevant relationships by carlotta francesca cartia, source=Web Response No relevant relationships by Amilcar DI-GERONIMO, source=Web Response No relevant relationships by Francesco Leo, source=Web Response No relevant relationships by Huong Lien PHAM FAISEAUX, source=Web Response