Successful Pleurodesis Research Articles

Fast pleurodesis combining talc poudrage and indwelling pleural catheter for the management of recurrent malignant pleural effusions

Background and objectivesMalignant pleural effusions (MPE) are a frequent and major turning point in neoplastic disease usually leading to poor life expectancy. Improve quality of life and relieve the dyspnea are the main objectives in this palliative care setting. This can be achieved by the placement of an indwelling catheter (IPC) or talc pleurodesis ideally performed by thoracoscopy route (talc poudrage). Beside to misidentify a trapped-lung, the latter requires a prolonged hospital stay and the IPC placement does not allow a high pleurodesis rate. To overcome these drawbacks, a combination of both technique could be proposed for the management of recurrent malignant pleural effusions. Safety and efficacy of this pragmatic approach are reported. MethodsConsecutive patients who have been managed for recurrent MPE by a combination of talc poudrage for pleural symphysis by thoracoscopy route ending with the insertion of IPC using the same thoracic point of entry. Demographic data, hospital length of stay (LOS), procedural-related complications, patients’ quality of life (QoL) and success of pleurodesis were collected. Patients were followed-up for 6 months. ResultsThe data of twenty-five consecutive patients undergoing the procedure were analyzed. Successful pleurodesis was obtained for 14/25 patients (66 %) at one month, 17/20 patients (85 %) at 3 months and 13/15 patients (86 %) at 6 months respectively. On average, the hospital LOS after the procedure was 3.24 days (IQR 1–4) with a median of 1 day. A prolonged hospitalization (>1 day) was never due to the procedure except for one patient (pneumothorax). No IPC related infection or procedure related deaths were noted. ConclusionAmong patients with recurrent MPE, the combination of talc poudrage symphysis by thoracoscopy route and IPC placement on the same time results in a shortened hospital LOS and higher rate of pleurodesis. Further randomized clinical trials are needed to confirm these results.

Lung ultrasound in a nutshell. Lines, signs, some applications, and misconceptions from a radiologist's point of view. Part 2.

In recent years, lung ultrasound (LUS) has developed rapidly, and it is gaining growing popularity in various scenarios. There are constant attempts to introduce it to new fields. In addition, knowledge regarding lung and LUS has been augmented by the recent COVID-19 pandemics. In the first part of this review we discuss lines, signs and pheno-mena, profiles, some applications, and misconceptions. An aim of the second part of the review is mainly to discuss some advanced applications of LUS, including lung elastography, lung spectroscopy, colour and spectral Doppler, contrast-enhanced ultrasound of lung, speckled tracking of pleura, quantification of pulmonary oedema, predicting success of talc pleurodesis, asthma exacerbations, detecting chest wall invasion by tumours, lung biopsy, estimating pleural effusion volume, and predicting mechanical ventilatory weaning outcome. For this purpose, we reviewed literature concerning LUS.

Successful Autologous Blood Patch Pleurodesis: A Safe and Useful Treatment for Persistent Pneumothorax in Former Pulmonary Tuberculosis and Aspergillosis in Pregnant Women

Background: Autologous Blood Patch Pleurodesis (ABPP) is one of the treatment options for persistent pleural air leaks especially in patients who are not suitable for surgical intervention. Persistence pneumothorax is defined as pneumothorax of more than five days duration. It is associated with increased morbidity and cost of care. The most widely accepted treatment for it is pleurodesis. Several types of pleurodesis have been proposed, including surgical approaches and the instillation of different chemicals in the intrapleural space. ABPP has proven to be a simple, inexpensive, efficacious and safe method. We present the case of the first patient with Persistent Pneumothorax we have treated Successfully with ABPP. ABPP is currently rarely and uncommonly used, but it provides benefits especially in special conditions with easier, cheaper, and quite effective procedures.
 Case: A female 35-year-old pregnant women patients with Former Tuberculosis (FTB) come to our hospital with complaints breathlessness and chest pain worsening since 3 days before admitted to our hospital. Chest radiography showed spontaneous pneumothorax with GeneXpert (GE) sputum Mtb Not Detected but there is Aspergillosis from Fungal Culture. Water Sealed Drainage (WSD) was inserted in right pleural for almost 1 month and this patient discharge with pneumostat. One month after that she come again with Persistence Pneumothotax, so that we do the pleurodesis with Blood Patch and get the improvement from clinical status. Antifungals are continued for an initial 4-6 weeks while an outpatient evaluation is conducted.
 Conclusion: ABPP is a safe, inexpensive and efficacious treatment for persistent pleural air leak. Autologous Blood Patch administration may be considered for patients with Persistent Pneumothorax.

Successful pleurodesis of refractory pleural effusion caused by he-art failure due to restrictive cardiomyopathy caused by amyloidosis

Successful pleurodesis of refractory pleural effusion caused by he-art failure due to restrictive cardiomyopathy caused by amyloidosis

Comparison of outcomes of surgical and other invasive treatment modalities for malignant pleural effusion in patients with pleural carcinomatosis.

Treatment modalities for malignant pleural effusion (MPE) are diverse. The objectives were to analyze actual clinical data from patients with MPE and pleural carcinomatosis and to compare the outcomes of different treatment modalities with regard to effectiveness, survival, morbidity, and mortality as well as the duration of hospitalization. Patients with pathologically proven pleural carcinomatosis or MPE from 2018 to 2020 were included in this retrospective-observational study with additional questionnaires. We identified four treatment modalities: (I) video-assisted thoracic surgery with pleurodesis (VATS, mechanical/chemical); (II) VATS with pleurodesis combined with indwelling pleural catheter (IPC) placement; (III) VATS (without pleurodesis) combined with IPC placement; and (IV) management with IPC placement alone. We enrolled 91 patients aged 38-90 years who were treated by either VATS-pleurodesis (N=22), VATS-IPC placement (N=21), a combination of VATS with pleurodesis and IPC placement (N=22), or IPC placement alone (N=26). The mean survival time was 138.3 days. No significant differences were detected among treatment groups regarding the outcome of pleurodesis failure, either initially or later. Patients in the VATS-pleurodesis with IPC group experienced significantly more complications than those in the other treatment modality groups [odds ratio (OR): 3.288, P=0.026]. However, no statistically significant differences were observed regarding the type of adverse event and survival. Hypoalbuminemia, systemic therapy, and successful pleurodesis (P=0.008; P=0.011; P=0.044, respectively) were significantly correlated with survival. In multiple linear regression, hypoalbuminemia persisted as an independent predictor of survival (P=0.031). The type of intervention showed significant differences regarding the duration of hospitalization (P=0.017). IPC placement alone shortened the mean total hospitalization time by 7.9, 5.9, and 7.0 days compared to VATS-pleurodesis (P≤0.001), VATS-IPC placement (P=0.004), and VATS-pleurodesis with IPC placement (P≤0.001), respectively. The survival time was very short, and each treatment group had pros and cons. Therefore, decisions should be made on a case-by-case basis. The use of an IPC, even if the lung is not trapped, can significantly reduce the length of hospital stay. VATS is needed when histology is needed. The ideal method for treating recurrent MPE should be simple, effective, and inexpensive, with minimal disturbance to the patient.

Indwelling pleural catheters for persistent pleural effusions secondary to post lung resection for malignancies.

Malignant and nonmalignant pleural effusions (NMPEs) such as those due to hepatic hydrothorax have been successfully treated with an indwelling pleural catheter (IPC) with a low complication rate. There is no literature on the utility or safety of this treatment modality for NMPE post lung resection. We aimed to assess the utility of IPC for recurrent symptomatic NMPE secondary to post lung resection in lung cancer patients over a period of 4 years. Patients who underwent lobectomy or segmentectomy as part of the treatment plan for lung cancer between January 2019 and June 2022 were identified, these patients were screened for post-surgical pleural effusion. A total of 422 underwent lung resection, of which 12 had recurrent symptomatic pleural effusions requiring IPC placement and were selected for final analysis. The primary end points were improved symptomatology and successful pleurodesis. Mean time to IPC placement was 78.4 days post-surgery. The mean length of IPC catheter was 77.7 days standard deviation (SD) 23.8. All 12 patients achieved spontaneous pleurodesis (SP), there was no second pleural intervention or re-accumulation of fluid on follow up imaging in any of the subjects after IPC removal. Two patients (16.7%) had skin infection related to catheter placement that was managed with oral antibiotics, there were no cases of pleural infections that required catheter removal. IPC is a safe and effective alternative in managing recurrent NMPE post lung cancer surgery with high rate of pleurodesis and acceptable complication rates.

The Impact of Anticoagulation on Indwelling Pleural Catheter Removal due to Pleurodesis in Patients with Malignant Pleural Effusion

Background: A well-recognized therapy to improve the symptoms of patients with malignant pleural effusion (MPE), indwelling pleural catheters (IPCs) can also achieve spontaneous pleurodesis. Chemical pleurodesis is associated with a significant pro-coagulation and fibrinolytic environment. Hence, anticoagulation could theoretically interfere with this process. Objective: The aim of this study was to evaluate if anticoagulation can interfere with successful spontaneous pleurodesis in patients treated with IPC. Methods: This was a cohort study of all patients with MPE treated with IPC. The primary objective was to determine if anticoagulant use after IPC placement decreased the rate of spontaneous pleurodesis. The secondary objective was to identify other factors associated with spontaneous pleurodesis. We used a Fine-Gray subdistribution hazard model and a direct acyclic graph to identify variables associated with time to spontaneous pleurodesis. Results: Of the included 410 patients, 210 patients (51.2%) achieved pleurodesis and had their IPC removed. We found no association between anticoagulation and likelihood of pleurodesis. Multivariate analyses revealed that prior chemotherapy, ECOG score of 2–4 were associated with unsuccessful pleurodesis, while chemotherapy or radiotherapy after IPC placement remained associated with increased likelihood of spontaneous pleurodesis. Conclusions: We failed to demonstrate an association between anticoagulation and pleurodesis. We found that better performance status and chemotherapy or radiotherapy after IPC placement can increase the rate of pleurodesis and catheter removal.

Transthoracic sonographic scores in evaluating the success of different scelerosing modalities in patients with malignant pleural effusion

BackgroundMalignant pleural effusions (MPE) mostly arises from metastases to the pleura from other sites. Management of malignant effusions aims to palliate dyspnea and prevent the reaccumulation of pleural fluid to improve patients’ quality of life. Pleurodesis is the most common palliative treatment for patients with refractory MPE. This study was carried out to evaluate the performance of transthoracic sonographic (TUS) scores (pleural sliding and pleural adherence score) in predicting the success of pleurodesis by different modalities in patients with malignant pleural effusion. One hundred malignant pleural effusion patients were enrolled to an interventional clinical trial from September 2019 to April 2021 for palliative management of dyspnea. Pleurodesis for palliative treatment of dyspnea was done either spontaneously by the intercostal chest tube or by a sclerosing agent such as tetracycline solution or tetracycline poudrage or iodopovidine. Patients were randomly allocated to one of these four groups where each group included 25 patients. Transthoracic ultrasound was performed at baseline, and 1 month after pleurodesis and the lung sliding score and pleural adherence score were evaluated.ResultsMajority of patients (78%) had high baseline lung sliding score (7-8). Post pleurodesis only 11.4% had high scores (p<0.001), also the mean lung sliding score decreased significantly in comparison to the baseline values (p˂ 0.001) in the spontaneous, tetracycline solution, tetracycline poudrage, and iodopovidine groups (7.04 ± 1.02 vs. 4.85 ± 1.60, 7.28± 0.98 vs. 4.48± 1.75, 7.20±0.96 vs. 4.44 ± 1.45, 7.04±0.93 vs. 3.35±1.81, respectively). Iodopovidine pleurodesis group in comparison to the other modalities showed the highest pleural adherence score (12.64 ± 2.98) and absent lung sliding in 72.7% of cases and 70 % success rate. Pleural adherence score at cut off ≥ 12 showed 92.75% sensitivity, 89.47% specificity, 92.1 accuracy, and 0.911 area under the curve (AUC) for predicting successful pleurodesis.ConclusionTUS scores is a feasible, bedside, and accurate method to detect the outcome of pleurodesis. Iodopovidone was more effective than tetracycline solution, tetracycline poudrage, and spontaneous pleurodesis.Trial registrationClinicalTrials.gov. NCT04074902. Registered on 29 August 2019

Assessment of diaphragmatic mobility by chest ultrasound and basic echocardiography in patients with malignant pleural effusion undergoing pleurodesis

Background Malignant pleural effusion (MPE) is prevalent, and in cases such as aging patients as well as increased long-term survival for metastatic cancers, the number of patients will continue to elevate in the near future. Aim To assess both the diaphragmatic mobility using chest ultrasound and basic echocardiography before and after pleurodesis in patients with MPE. Patients and methods This study included 35 patients with MPE; the diagnosis is based on positive pleural fluid cytology, thoracoscopic biopsy, and fitted for chemical pleurodesis by bleomycin. Baseline chest ultrasound was done to for assess the diaphragmatic mobility and basic echocardiography. Chemical pleurodesis was done through intrapleural injection of 1 IU/kg bleomycin as a sclerosing agent in 100 ml of normal saline. Results Regarding outcome, 17 (48.6%) patients succeeded (defined as absent lung sliding and no reaccumulation of pleural fluid in the lines examined) and 7 (20%) patients failed (known as reaccumulation of pleural fluid and (even with) no presence of lung sliding). There was a statistically substantial decrease in the diaphragmatic excursion (mobility) at 2 weeks and at 2 months after pleurodesis than before. A significant relation was detected between outcome of the studied patients with lung sliding before pleurodesis, whereas there was a substantial increase in pleurodesis success with no presence of lung sliding at 2 weeks and at 2 months after pleurodesis. Conclusion Ultrasound of the diaphragm is an uncomplicated, noninvasive method for estimating the contractile activity of diaphragm. The decrease in the diaphragmatic excursion at 2 weeks and at 2 months after pleurodesis compared with that before pleurodesis can be used as sign to predict pleurodesis success. There is no significant relation between echocardiography measurements and outcome except that normal left ventricle ejection fraction % has a significant relation with increased success outcome.

The Treatment of Malignant Pleural Effusion With Permanent Indwelling Pleural Catheters.

40 000 to 60 000 people develop malignant pleural effusion (MPE) in Germany each year. The most common causes are lung cancer and breast cancer. Patients with pleural carcinomatosis have a median survival time of four months. We investigated the current health services situation regarding treatment with indwelling pleural catheters (IPC) versus talc pleurodesis (TP) in Germany based on registry data from the Federal Statistical Office, the Pleural Tumor Registry of the German Society for Thoracic Surgery, and the IPC registry of the ewimed GmbH company. In addition, we conducted a selective literature review on IPC and TP. The symptoms of dyspnea and thoracic pressure determine the need for therapy in MPE. Both TP and IPC are effective treatment options for MPE. Both therapeutic procedures are considered equally effective with respect to the relief of dyspnea, post-interventional quality of life, and complication rates. TP yields a higher rate of successful pleurodesis than IPC (relative risk: 1.56; 95% confidence interval: [1.26; 1.92]; p < 0.0001), while patients who receive an IPC stay in the hospital for a shorter time than those who undergo TP (a difference of slightly more than two days). The survival of patients with MPE is not affected by which of the two local therapeutic procedures is chosen. The indication for either IPC or TP needs to be determined individually for each patient on the basis of his or her general condition, symptoms, clinical situation ("trapped lung"), and prognosis.

Association between terminal pleural elastance and radiographic lung re-expansion after therapeutic thoracentesis in patients with symptomatic pleural effusion: a post-hoc analysis of a randomised trial

ObjectivesRecurrent symptomatic effusions can be durably managed with pleurodesis or placement of indwelling pleural catheters. Recent pleurodesis trials have largely relied on lung re-expansion on post-thoracentesis radiograph as an inclusion...

Role of chest ultrasound in management of exudative pleural effusion

Background: During the planning and execution of diagnostic and therapeutic procedures, thoracic ultrasonography is an appropriate imaging tool for the interventional pulmonologist (IP). Aim of the work: to determine whether or not thoracic ultrasonography should be used in the management of exudative pleural effusion. Patients and Methods: One hundred patients with exudative pleural effusion were included in a prospective interventional analytical study. During this study, the patients underwent ultrasonographic examination and evaluation to guide various diagnostic manoeuvres. These manoeuvres included diagnostic thoracentesis, tru cut needle biopsy from pleural or underlying lung or mediastinal lesions, and thoracoscopic assistance. In addition to assisting in therapeutic operations (such as therapeutic thoracentesis, installation of pleural drains, and pleurodesis), ultrasound was also used for prognostic reasons (post-pleural drainage assessment, pleural drain follow up, non-expandable lung prediction, and pleurodesis success detection). Results: 70 patients underwent ultrasound-guided diagnostic procedures, including diagnostic thoracentesis in 19 patients, biopsy from pleural, lung, or mediastinal lesions in 30 patients, and thoracoscopic assistance in 21 patients in order to select the appropriate type of intervention, either medical thoracoscopy (MT) or video-assisted thoracoscopic surgery (VATS).

Modified indwelling pleural catheter versus silver nitrate pleurodesis for the management of malignant pleural effusion

Background About half of the patients suffering from malignant pleural effusion (MPE) complain of dyspnea with poor quality of life. Objective The aim of this study was to compare the efficacy and safety of silver nitrate pleurodesis (SNP) via tube thoracostomy and modified indwelling pleural catheter (IPC) in the management of patients complaining of recurrent symptomatic MPE. Patients and methods This two-arm, nonblinded interventional study (randomized controlled trial) was conducted between April 2018 and October 2019. In all, 45 patients were involved in this study and were randomly divided into two groups. Group I (SNP via tube thoracostomy, SNP group) including 21 patients and group II (modified IPC, IPC group) including 24 patients. Findings All enrolled patients had either moderate or massive pleural effusions. The majority of cases (61.9% of the SNP group and 69.6% of the modified IPC group) had successful pleurodesis. Mean hospital stay was significantly lower among the modified IPC group in comparison to the SNP group. The modified IPC group had a significantly higher chest pain score and higher dyspnea score at 1-month postprocedure in comparison to the SNP group. Interpretation SNP via intercostal tube and modified IPC pleurodesis for the management of recurrent symptomatic MPE were nearly equally effective with a high success rate and low tolerable complications. Both methods were safe and inexpensive in the achievement of pleurodesis. Modified IPC pleurodesis had the advantage of a single-day procedure and shorter hospital stay.

Determination of In Vivo efficacy and safety of zeolite as a new pleurodesis agent

Pleural effusion, the pathological condition in which an abnormal amount of pleural fluid is accumulated in the small space between the visceral and parietal pleurae of the lungs, can be treated by pleurodesis, whereby the pleural space is obliterated. This effect can be achieved by chemical pleurodesis utilizing various reagents such as talc, an agent commonly employed in pleurodesis. Zeolites, microporous tectosilicates found in nature as minerals, can be used in a wide range of medical applications. Different zeolite compounds may exhibit variable efficacy and safety profiles, mainly depending on their particle size. In this study, we evaluated the efficacy and safety of zeolite pleurodesis. New Zealand rabbits were administered 400 mg/kg of either agent dissolved in 2 mL of isotonic saline solution by injection into their pleural cavity, and computed tomography images were obtained on postoperative day 26. Euthanization was conducted at the end of 28 days for histopathological evaluation. Furthermore, subacute toxicity and mutagenicity profiles of zeolite were analyzed. Our findings revealed that zeolite was able to induce an adequate inflammatory response to achieve successful pleurodesis. The adhesion profiles were in favor of zeolite when compared to talc pleurodesis. Moreover, none of the tested doses of zeolite induced subacute toxicity or mutagenesis. Collectively, our results suggested zeolite as an effective and safe pleurodesis agent.

Ambulatory Thoracoscopic Pleurodesis Combined With Indwelling Pleural Catheter in Malignant Pleural Effusion.

Background and Objective: Malignant pleural effusion (MPE) often results in debilitating symptoms. Relief of dyspnoea and improvement in quality of life can be achieved with either talc pleurodesis or insertion of an indwelling tunneled pleural catheter (IPC). The former requires a lengthy hospital stay and the latter is associated with lower pleurodesis rates. In response to limited hospital bed capacity, we developed a pragmatic approach in managing MPE by combining thoracoscopic talc poudrage and insertion of IPC into a single day case procedure. We present data on the safety and efficacy of this approach.Methods: Patients who had undergone the abovementioned procedure between 2017 and 2020 were analyzed. Demographic data, hospital length of stay (LOS), histological diagnosis, rates of pleurodesis success and procedural related complications were collated. Patients were followed-up for 6 months.Results: Forty-five patients underwent the procedure. Mean age was 68.5 ± 10.4 years and 56% were male. Histological diagnosis was achieved in all cases. 86.7% of patients were discharged on the day of the procedure. Median LOS was 0 (IQR 0–0) days. Successful pleurodesis was attained in 77.8% at 6-month follow-up. No procedure related deaths or IPC related infections were recorded.Conclusion: Ambulatory thoracoscopic poudrage and IPC insertion is a safe and effective option in the management of MPE. All patients received a definitive pleural intervention with 77.8% pleurodesis success at 6-months and majority of them discharged on the same day. Future randomized trials are required to confirm these findings.

Bedside ultrasonography to determine pleurodesis success: SIMPLE but how sound?

Chemical pleurodesis—the iatrogenic sealing of the pleural cavity using a sclerosant—is commonly practised worldwide. More than 10 000 pleurodesis procedures are carried out each year in the USA alone for malignant pleural effusions (MPEs). Talc remains the most efficacious sclerosing agent, and all randomised controlled trials to date have found delivering talc as a slurry via a chest tube to be as effective as its insufflation (poudrage) thoracoscopically.1 Hence, talc slurry pleurodesis remains a key option in MPE management guidelines.

Role of thoracic ultrasonography in pleurodesis pathways for malignant pleural effusions (SIMPLE): an open-label, randomised controlled trial

Pleurodesis is done as an in-patient procedure to control symptomatic recurrent malignant pleural effusion (MPE) and has a success rate of 75-80%. Thoracic ultrasonography has been shown in a small study to predict pleurodesis success early by demonstrating cessation of lung sliding (a normal sign seen in healthy patients, lung sliding indicates normal movement of the lung inside the thorax). We aimed to investigate whether the use of thoracic ultrasonography in pleurodesis pathways could shorten hospital stay in patients with MPE undergoing pleurodesis. The Efficacy of Sonographic and Biological Pleurodesis Indicators of Malignant Pleural Effusion (SIMPLE) trial was an open-label, randomised controlled trial done in ten respiratory centres in the UK and one respiratory centre in the Netherlands. Adult patients (aged ≥18 years) with confirmed MPE who required talc pleurodesis via either a chest tube or as poudrage during medical thorascopy were eligible. Patients were randomly assigned (1:1) to thoracic ultrasonography-guided care or standard care via an online platform using a minimisation algorithm. In the intervention group, daily thoracic ultrasonography examination for lung sliding in nine regions was done to derive an adherence score: present (1 point), questionable (2 points), or absent (3 points), with a lowest possible score of 9 (preserved sliding) and a highest possible score of 27 (complete absence of sliding); the chest tube was removed if the score was more than 20. In the standard care group, tube removal was based on daily output volume (per British Thoracic Society Guidelines). The primary outcome was length of hospital stay, and secondary outcomes were pleurodesis failure at 3 months, time to tube removal, all-cause mortality, symptoms and quality-of-life scores, and cost-effectiveness of thoracic ultrasonography-guided care. All outcomes were assessed in the modified intention-to-treat population (patients with missing data excluded), and a non-inferiority analysis of pleurodesis failure was done in the per-protocol population. This trial was registered with ISRCTN, ISRCTN16441661. Between Dec 31, 2015, and Dec 17, 2019, 778 patients were assessed for eligibility and 313 participants (165 [53%] male) were recruited and randomly assigned to thoracic ultrasonography-guided care (n=159) or standard care (n=154). In the modified intention-to-treat population, the median length of hospital stay was significantly shorter in the intervention group (2 days [IQR 2-4]) than in the standard care group (3 days [2-5]; difference 1 day [95% CI 1-1]; p<0·0001). In the per-protocol analysis, thoracic ultrasonography-guided care was non-inferior to standard care in terms of pleurodesis failure at 3 months, which occurred in 27 (29·7%) of 91 patients in the intervention group versus 34 (31·2%) of 109 patients in the standard care group (risk difference -1·5% [95% CI -10·2% to 7·2%]; non-inferiority margin 15%). Mean time to chest tube removal in the intervention group was 2·4 days (SD 2·5) versus 3·1 days (2·0) in the standard care group (mean difference -0·72 days [95% CI -1·22 to -0·21]; p=0·0057). There were no significant between-group differences in all-cause mortality, symptom scores, or quality-of-life scores, except on the EQ-5D visual analogue scale, which was significantly lower in the standard care group at 3 months. Although costs were similar between the groups, thoracic ultrasonography-guided care was cost-effective compared with standard care. Thoracic ultrasonography-guided care for pleurodesis in patients with MPE results in shorter hospital stay (compared with the British Thoracic Society recommendation for pleurodesis) without reducing the success rate of the procedure at 3 months. The data support consideration of standard use of thoracic ultrasonography in patients undergoing MPE-related pleurodesis. Marie Curie Cancer Care Committee.

The Association Between Pleural Fluid Exposure and Survival in Pleural Mesothelioma

Most patients with malignant pleural mesothelioma (MPM) seek treatment with malignant pleural effusion (MPE). Invitro evidence suggests that MPE may not be a simple bystander of malignancy, but rather potentially has biological properties that improve cancer cell survival and promote cancer progression. If this is the case, MPE management may need to shift from current symptomatic strategies to aggressive fluid removal to impact survival. Is there an association between pleural fluid exposure and survival in MPM? Data from 761 patients who received a diagnosis of MPM between 2008 and 2018 were collected from patient medical records in three UK pleural units. Data included factors previously identified as influencing prognosis in MPM. Medical imaging was reviewed for presence, size, and duration of pleural effusion. Time-dependent covariate analysis of pleural fluid exposure and survival (model included weight loss, serum albumin, hemoglobin, MPM subtype, performance status, chemotherapy, and age) and multivariate Cox regression analysis of pleurodesis and survival were conducted. Median overall survival was 278days (interquartile range, 127-505days; 95%CI, 253-301days). Pleural fluid exposure duration showed no association with survival (hazard ratio, 1.0; 95%CI, 1.0-1.0). Median survival was 473, 378, and 258days with complete, partial, and no pleurodesis (P= .008). Pleurodesis success seems to be associated with improved survival; however, it is unclear whether duration of MPM exposure to pleural fluid is associated with survival within the limitations of this retrospective study. Future prospective studies are required to assess this potentially important mechanism.

Thoracoscopic Talc Insufflation Versus Talc Slurry in Patients with Malignant Pleural Effusion

Background: Malignant Pleural Effusion (MPE) is defined as an accumulation of pleural fluid in which malignant cells are present. It is a poor clinical indicator as it represents an advanced stage neoplasm with median survival ranging from one to 12 months. Aim: We aimed at comparing Thoracoscopic Talc Insufflation with tube thoracostomy talc slurry pleurodesis in regard to the efficacy and complications in patients with MPE. Patients and Methods: 128 patients with MPE were divided into two groups, 64 in each. One group had tube thoracostomy talc slurry (TS) pleurodesis while the other had thoracoscopic talc insufflation (TTI) pleurodesis. Results: Talc slurry was associated with a longer hospital stay. Complications recorded included chest pain (TS 29%, TTI 25.4%), dry cough (TS 16%, TTI 39%), vomiting (TS 29%, TTI 13.6%), tachycardia (TS 16.13%, TTI 18.64%), surgical wound infection (TS 11.29%, TTI 10.17%), and respiratory failure complicating talc pneumonitis (TS 3.23%, TTI 0%). Pleurodesis success was enhanced by the presence of lung cancer (OR 2.34, p=0.02) or breast cancer (OR 2.55, p= 0.03) as the primary malignancy, the younger the patient's age at pleurodesis time (OR 1.004, p=0.89) and the higher the pleural fluid glucose content (OR 1.01, p=0.09). Pleurodesis failure was strongly correlated to the presence of any of the pre-procedural factors, female gender, hepatocellular carcinoma as the primary malignancy, and low pH pleural fluid. Conclusion: In MPE patients with no evidence of lung trapping, talc pleurodesis method used should depend on local expertise (availability of thoracoscopy), whether additional tissue is needed for molecular-marker analysis (would favor thoracoscopy), plus patient-related factors (operable or not). However, TTI has a significant irrefutable benefit in patients with adhesions and trapped lung.

Survival and pleurodesis outcome in patients with malignant pleural effusion – a systematic review

Abstract Malignant pleural effusion (MPE) is a common condition that presents with progressive breathlessness. Long term solutions are often required due to recurrence of effusion after simple drainage. Pleurodesis is one of the main options resorted to for long term control of MPE. There is data to suggest there may be a survival benefit for patients with MPE who achieve successful pleurodesis. A systematic review was carried out to explore this correlation and results suggest that there could be a survival difference according to pleurodesis outcome in patients with MPE. Fifteen studies (reported in 13 papers) were included; 13 (86.6%) of the studies showed survival difference in favour of pleurodesis success. The median [interquartile range] difference in survival between the two groups among the different studies was five [3.5–5.8] months. Most of the included studies suffered moderate to severe risk of bias and, thus, large prospective studies of patients undergoing pleurodesis are required to ascertain this effect.