Chest Tube Pleurodesis Research Articles

Small-caliber tube drainage and rapid pleurodesis in malignant pleural effusion

Objectives The aim of this study was to compare between small-caliber catheter rapid pleurodesis and conventional chest tube pleurodesis as regards efficacy and hospital stay in patients with malignant pleural effusion (MPE). Background Chemical pleurodesis can be palliative for recurrent, symptomatic pleural effusions in patients who are not candidate for a thoracic surgical procedure. We hypothesized that pleurodesis as effective as the standard method could be accomplished with a rapid method of pleurodesis. Patients and methods This prospective randomized controlled trial included 30 patients with MPE. Patients were divided into two groups: group A, which underwent rapid pleurodesis with a small-caliber tube (8–14 Fr), and group B, which underwent conventional pleurodesis. Talc was the sclerosing agent that was used. The small-caliber tube was inserted under local anesthesia with total evacuation of pleural fluid, maximum 1.5 l, followed by gradual evacuation. Rapid pleurodesis was performed only after obtaining radiological evidence of complete evacuation of the fluid and the tube was clamped for 1 h. The fluid was drained over 1 h and the catheter removed and the patient discharged. The chest tube was inserted under local anesthesia with total evacuation of pleural fluid, maximum 1.5 l, followed by gradual evacuation. Pleurodesis was performed only after obtaining radiological complete evacuation of the fluid, daily drainage of less than 300 l. The tube was clamped for 1 h. The fluid was drained over 6–12 h and the tube was removed and then the patient was discharged from hospital. Results Our study included 15 patients in group A who underwent rapid pleurodesis and 15 patients in group B who underwent conventional pleurodesis. There was a significant difference between the two groups as regards hospital stay and postoperative pain. Conclusion Small-caliber tube drainage and rapid pleurodesis were shown to be efficient and demonstrated a good safety profile in treating MPEs.

Survey of Pulmonologistsʼ Perspectives on Thoracoscopy

Thoracoscopy is used increasingly as a diagnostic and therapeutic procedure in patients with pleural and pulmonary disease by thoracic surgeons and pulmonologists. The thoracic surgical community, through research and publications, has clearly delineated its scope in surgical practice. Data pertaining to pulmonologists' perceptions of thoracoscopy, however, are lacking. We surveyed a group of physicians attending a pleural disease course at the American Lung Association/American Thoracic Society 1999 International Conference to understand better the role of thoracoscopy in a pulmonologist's practice. A 14-item questionnaire was administered to all 142 attendees. Comparison of responses between groups was performed with the chi-square test, and p ≤ 0.05 was considered significant. One hundred forty-one fully completed questionnaires were analyzed. Ninety percent (n = 128) surveyed were pulmonologists, 9% (n = 12) were trainees, and 1% (n = 1) was not a pulmonologist. The majority worked in academic institutions and had been in practice for 5 years. Twenty-three percent reported having performed thoracoscopy, of which 10% practiced in the United States. Most preferred thoracoscopy to closed needle biopsy and chest tube pleurodesis, and were of the opinion that its role in pulmonary practice, although currently limited by the lack of training opportunities, was likely to increase in the future. Thoracoscopy was considered a valuable addition to a pulmonologist's armamentarium and could be performed by trained pulmonologists.

Management of recurrent spontaneous pneumothorax and recurrent symptomatic pleural effusion with chest tube pleurodesis.

Management of recurrent spontaneous pneumothorax and recurrent symptomatic pleural effusion with chest tube pleurodesis.