Therapy

Perform pleurodesis once ^d after the chest tube is draining < 150 ml of fluid per day. ^d There is no clear benefit from rotating the patient immediately after insertion of the sclerosant. ^d

Why?

• Multiple instillations of tetracycline are not clearly better than a single instillation at preventing recurrence of malignant pleural effusions. ^d
• Pleurodesis following a short period of drainage is not clearly better than waiting until < 150 ml drains a day, and may well be worse. ^d
• Patients who roll around during chemical pleurodesis do not clearly have a less chance of recurrence of the effusion than those that do not. ^d