Pleural effusions: pleurodesis: rotation of the patient was not clearly beneficial.

Clinical bottom line (level 1b-)

  1. Patients who do roll around during chemical pleurodesis may have less chance of recurrence of the effusion than those that do not, but there was no clear difference.
Dryzer et al: Chest 1993; 104 (6): 1763-1766
Expires October 2003

The study

Unblinded ?concealed randomised trial without intention-to-treat
Setting: university hospital, USA

40 patients (aged mean 63 years, 65% male) chronic symptomatic pleural effusion requiring pleurodesis

Excluded if
  • received chemotherapy or radiotherapy within two weeks of study
  • lost to follow-up or died


    • Control Group: (n = 19, 19 analysed): two cycles of six positions: supine, prone, sitting, Trendelenburg, right and left lateral positions for ten minutes each
    Experimental Group: (n = 21, 21 analysed): supine for two hours
    All patients had a chest drain (24 to 36-French) placed in the affected hemithorax and fluid was drained by gravity. Once < 150 ml/ day was passing and chest x-ray showed re-expansion of the lung, instillation was begun. Patients received 15ml of 1% lidocaine intrapleurally, followed by tetracycline 20 mg/kg, minocycline 300 mg or doxycycline 500 mg intrapleurally, diluted in 50 ml of normal saline. The tube was then clamped. After two hours the chest drain was unclamped and placed with 20 cm H2O suction, until drainage < 150 ml/ day, when it was removed.
    100% followed for 30 days
    Outcome notes:
    • treatment failure : continued chest tube drainage > 300 ml for three or more days after installation; requirement of second installation of tetracycline; recurrence of effusion on chest X-ray

    The evidence

    Outcome Time to outcome CEREERRRR
    (95% CI)    		ARR
    (95% CI)    		NNT
    (95% CI)
    treatment failure 30 days 5
    (26.3%)    		 8
    (38.1%)    		 -45%
    (-267% to 43%)    		 -11.8%
    (-40.5% to 16.9%)    		 -8
    (NNT = 6 to infinity;
    NNH = 2 to infinity)

    Comments

    1. The study is too small to show any potential increase in benefit from rotating.

    Citation

    1. Dryzer SR, Allen ML, Strange C, et al: comparison of rotation and nonrotation in tetracycline pleurodesis. Chest 1993; 104 (6): 1763-1766
    Search Terms: pleural effusion in Cochrane
    Contributor: Chris Ball and Clare Wotton, October 2000
    Reviewer:

    Clinical Question.
    Patient pleural effusion
    Intervention or Exposure roll around during chemical pleurodesis
    Comparison supine
    Outcome recurrence