Pleural effusion: malignant: smaller chest drains were more comfortable

Clinical bottom line (level 1b)

  1. Patients with recurrent malignant pleural effusions who had a small bore chest tube compared with a large bore inserted were less likely to find the insertion worse than thoracentesis (NNT = 2 at unknown) , and less likely to find the tube uncomfortable (NNT = 1 at unknown) .
  2. There was no clear effect on the need for recurrent thoracentesis, although the study was too small to demonstrate this.
Clementsen et al: Respiratory Medicine 1998; 92 (3): 593-596
Expires October 2003

The study

Single-blinded ?concealed randomised trial without intention-to-treat
Setting: acute hospital, Denmark

21 patients (aged mean 68, 50% male) with recurrent malignant pleural effusion undergoing diagnostic thoracoscopy
Control Group: (n = 10, 9 analysed): large-bore chest tube (24 gauge) placed during diagnostic thoracoscopy
Experimental Group: (n = 11, 9 analysed): small percutaneous catheter inserted (Cystofix catheter) (10 gauge) during diagnostic thoracoscopy
All patients had pleurodesis performed using tetracycline following drainage.
100% followed for ? hospital discharge

The evidence

Outcome Time to outcome CEREERRRR
(95% CI)		ARR
(95% CI)		NNT
(95% CI)
insertion more uncomfortable than thoracentesis unknown 7
(77.8%)		 2
(22.2%)		 71%
(-2% to 92%)		 55.6%
(17.1% to 94.0%)		 2
(1 to 6)
chest tube somewhat or very uncomfortable unknown 9
(100%)		 2
(22.2%)		 78%
(25% to 93%)		 77.8%
(50.6% to 105%)		 1
(1 to 2)
need for recurrent thoracentesis unknown 2
(22.2%)		 3
(33.3%)		 -50%
(-590% to 68%)		 -11.1%
(-52.2% to 30.0%)		 -9
(NNT = 2 to infinity;
NNH = 3 to infinity)

Comments

  1. The study is too small to show the effect on the need for recurrent thoracentesis.
  2. No patient in the small catheter group found the tube very uncomfortable.

Citation

  1. Clementsen P, Evald T, Grode G, et al: Treatment of malignant pleural effusion: pleurodesis using a small percutaneous catheter: a prospective randomized study. Respiratory Medicine 1998; 92 (3): 593-596
Search Terms: thoracentes* or thoracocentes* in Cochrane
Contributor: Chris Ball and Bob Phillips, October 1999
Reviewer:

Clinical Question.
Patient malignant pleural effusion
Intervention or Exposure small percutaneous catheter for pleurodesis
Comparison large bore chest drain
Outcome unpleasantness