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  1. Jul 2018
    1. On 2017 Aug 12, Nikhil Meena commented:

      In our experience, Patients who don't appear to be candidates for a pleuroscopy may also be poor candidates for sclerosant therpay. http://journals.sagepub.com/doi/10.1177/1753465817721146

      Abstract BACKGROUND: Indwelling tunneled pleural catheters (TPCs) are increasingly being used to treat recurrent pleural effusions. There is also an increased interest in early pleurodesis in order to prevent infectious complications. We studied the time to removal and other outcomes for all the TPCs placed at our institution. METHODS: After institutional review board approval, records of patients who had had a TPC placed between July 2009 and June 2016 were reviewed; the catheters were placed in an endoscopy suite or during pleuroscopy with or without a sclerosant. The catheters were drained daily or less frequently and were removed after three drainages of less than 50 ml. RESULTS: During the study period 193 TPCs were placed. Of these 45 (23%) were placed for benign diseases. The commonest malignancy was lung cancer 70 (36%). Drainage 2-3 times a week without a sclerosant ( n = 100) lead to pleurodesis at 57 ± 78 days, while daily drainage after TPC + pleuroscopy + talc ( n = 41) achieved the same result in 14 ± 8 days ( p < 0.001). TPC + talc + daily protocol achieved pleurodesis in 19 ± 7 days, TPC + rapid protocol achieved the same result in 28 ± 19 days ( p = 0.013). The TPCs + sclerosant had an odds ratio of 6.01 (95% confidence interval: 2.1-17.2) of having a complication versus TPC without sclerosant. CONCLUSIONS: It is clear that TPCs when placed with a sclerosant had a significantly shorter dwell time; However, they were associated with higher odds of complications. One must be aware of these possibilities when offering what is essentially a palliative therapy.


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  2. Feb 2018
    1. On 2017 Aug 12, Nikhil Meena commented:

      In our experience, Patients who don't appear to be candidates for a pleuroscopy may also be poor candidates for sclerosant therpay. http://journals.sagepub.com/doi/10.1177/1753465817721146

      Abstract BACKGROUND: Indwelling tunneled pleural catheters (TPCs) are increasingly being used to treat recurrent pleural effusions. There is also an increased interest in early pleurodesis in order to prevent infectious complications. We studied the time to removal and other outcomes for all the TPCs placed at our institution. METHODS: After institutional review board approval, records of patients who had had a TPC placed between July 2009 and June 2016 were reviewed; the catheters were placed in an endoscopy suite or during pleuroscopy with or without a sclerosant. The catheters were drained daily or less frequently and were removed after three drainages of less than 50 ml. RESULTS: During the study period 193 TPCs were placed. Of these 45 (23%) were placed for benign diseases. The commonest malignancy was lung cancer 70 (36%). Drainage 2-3 times a week without a sclerosant ( n = 100) lead to pleurodesis at 57 ± 78 days, while daily drainage after TPC + pleuroscopy + talc ( n = 41) achieved the same result in 14 ± 8 days ( p < 0.001). TPC + talc + daily protocol achieved pleurodesis in 19 ± 7 days, TPC + rapid protocol achieved the same result in 28 ± 19 days ( p = 0.013). The TPCs + sclerosant had an odds ratio of 6.01 (95% confidence interval: 2.1-17.2) of having a complication versus TPC without sclerosant. CONCLUSIONS: It is clear that TPCs when placed with a sclerosant had a significantly shorter dwell time; However, they were associated with higher odds of complications. One must be aware of these possibilities when offering what is essentially a palliative therapy.


      This comment, imported by Hypothesis from PubMed Commons, is licensed under CC BY.