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Pleural Disease: Diagnosis and Management of Pleural Effusions


Monday, October 22, 2007

10:30 AM - 12:00 PM

SMALL-BORE CATHETERS FOR MANAGEMENT OF MALIGNANT PLEURAL EFFUSION IN LOW PERFORMANCE STATUS OUTPATIENTS

Ricardo M. Terra, MD*, Lisete R. Teixeira, MD, FCCP, Francisco S. Vargas, MD, FCCP, Paulo M. Pego-Fernades, MD, Eduardo H. Genofre, MD, FCCP and Fabio B. Jatene, MD

Thoracic Surgery Departament, Heart Institute, FMUSP, Sao Paulo, Brazil

PURPOSE: Pleurodesis is an effective approach in recurrent malignant pleural effusion (RMPE). Its success has been questioned in low performance status patients and there are few options for this population. The aim of this study was to analyze results of RPME management with small bore pleural catheters in low performance outpatients.

METHODS: Retrospective study. Symptomatic RMPE patients with Karnofsky Performance Status < 70 and >30 who underwent outpatient small-bore (14Fr) catheter placement. Talc pleurodesis was performed if radiography showed >90% in the 1st or 7th drainage day (patients with partial lung expansion). Patients with partial expansion remained catheterized until output < 100ml/day.

RESULTS: Forty-three patients (18 M, 25 F), age 61 ± 12 years underwent forty-five catheter placements (two were bilateral). Primary sites were: breast (19), lung (16), unknown (4), kidney (2), ovary (1) and head and neck cancer (1). They had a mean of 2.8 ± 1.2 previous thoracenteses. Immediate total lung expansion was observed in 19, gradual in 9 and partial in 17. Thirty pleurodesis were done and fifteen catheters were left long-term. Mean drainage time was 9.2 ± 4.8 days for pleurodesis and 27.6 ± 16.4 for long-term catheter. Fourteen complications occurred: obstruction (7), empyema (4), accidental loss (2), and fever (1). Prolonged drainage (> 15 days) and incomplete expansion were related to complications (p<0, 05). Recurrence occurred in five patients. Mean follow-up was 76 days.

CONCLUSION: Small-bore catheter for management of malignant pleural effusion is a safe and efficient method to do pleurodesis in low performance status outpatients.

CLINICAL IMPLICATIONS: RMPE in low performance status patients may be managed in an outpatient setting with acceptable success and complication rates. Prolonged drainage should be avoided.

DISCLOSURE: Ricardo Terra, No Financial Disclosure Information; No Product/Research Disclosure Information






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