Friday, July 31, 2015

Chemical Pleurodesis


  • accepted palliative therapy for patients with recurrent, symptomatic malignant pleural effusions.
  • Not all chemical agents have undergone direct comparison under similar conditions
  • Talc was the most effective agent (success rate of 93%). The most commonly reported adverse effects were pain and fever
  • In a systematic review, talc was the chemical agent that most frequently resulted in complete success (no recurrence of pleural fluid)
  • based on the more recent guidelines (BTS Pleural Disease Guideline 2010) only talc is recommended as part of the therapy



Indication

  • have significant symptoms that are relieved when pleural fluid is evacuated
  • evidence of complete re-expansion of the lung without evidence of bronchial obstruction or fibrotic trapped lung

Doxycycline

  • success rate of up to 80–85% in carefully selected patients
  • Most studies have recommended the utilization of 500 mg of doxycycline mixed with 50–100 cm3 of sterile saline
  • narcotic analgesic and/or conscious sedation is often recommended as pain is the most common complication

Administration

  • If is receiving corticosteroid therapy, the drug should be stopped or the dose reduced if possible because of concerns of decreased efficacy of pleurodesis
  • Most commonly, pleurodesis is performed via a standard tube thoracostomy
  • intravenous narcotic analgesics and/or sedation are often recommended because of the pain associated with many sclerosing agents
  • sclerosing agent of choice is then added to the chest tube, typically in a solution of 50–100 cm3 of sterile saline
  • chest tube is then clamped for 1 h, without rotation of the patient being required. 
  • The chest tube is then subsequently reconnected to 20 cm H2O suction. It is then recommended that suction be applied to the chest tube until the 24-h output from the chest tube is less than 150 cm3
References:
  1. www.uptodate.com
  2. https://www.brit-thoracic.org.uk/document-library/clinical-information/pleural-disease/pleural-disease-guidelines-2010/pleural-disease-guideline-quick-reference-guide/
  3. https://www.thoracic.org/statements/resources/pleural-disease/1987

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