Pleural effusion: pleurodesis: short-term chest drainage was probably not better than long-term.

Clinical bottom line (level 1b-)

  1. Patients with a moderate-to-large malignant pleural effusion had a very poor outcome.
  2. Pleurodesis following a short period of drainage was not clearly better than waiting until < 150 ml drains a day, and may well be worse.
Villenueva et al: Thorax 1994; 49: 23-25
Expires October 2003

The study

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

25 patients (aged range 41 to 81 years; median 69, 64% female) symptomatic moderate-to-large malignant pleural effusions (proven by cytology or pleural biopsy)

Excluded if
  • expected to survive < 1 month
  • previous chemical pleurodesis undertaken on the same effusion
  • ipsilateral atelectasis due to complete airway obstruction by endobronchial tumour


    • Control Group: (n = 15, 15 analysed): tetracycline instilled when lungs had re-expanded and fluid drained to < 150 ml/ day. Following installation the chest drain was removed once fluid drained < 150 ml/ day
    Experimental Group: (n = 10, 9 analysed): tetracycline instilled once lungs re-expanded on chest x-ray. Chest drain was removed the day after installation.
    All patients had standard tube thoracostomy suction drainage using a 28-French chest tube. 20 ml of 1% lidocaine was instilled followed by 1.5 g of tetracycline in 100-150 ml normal saline during pleurodesis.
    96% followed for 1-26 months
    Outcome notes:
    • non-response : recurrence of 50% or more of effusion or requirement for fluid drainage within one month

    The evidence

    Outcome Time to outcome CEREERRRR
    (95% CI)    		ARR
    (95% CI)    		NNT
    (95% CI)
    non-response 30 days 3
    (20.0%)    		 2
    (22.2%)    		 -11%
    (-443% to 77%)    		 -2.22%
    (-36.1% to 31.7%)    		 -45
    (NNT = 3 to infinity;
    NNH = 3 to infinity)
    death 1-26 months 13
    (86.7%)    		 9
    (100%)    		 -15%
    (-41% to 5%)    		 -13.3%
    (-30.5% to 3.87%)    		 -8
    (NNT = 26 to infinity;
    NNH = 3 to infinity)

    Comments

    1. The study is too small to show any potential increased failure from using a shorter drainage time.

    Citation

    1. Villenueva AG, Gray AW, Shahian DM, et al: efficacy of short term versus long term tube thoracostomy drainage before tetracycline pleurodesis in the treatment of malignant pleural effusions. Thorax 1994; 49: 23-25
    Search Terms: pleural effusion in Cochrane
    Contributor: Chris Ball and Clare Wotton, October 2000
    Reviewer:

    Clinical Question.
    Patient pleural effusion
    Intervention or Exposure short period of drainage
    Comparison standard drainage
    Outcome non-response, death