Indwelling Catheters Provide Better Management of Pleural Effusions
Indwelling Catheters Provide Better Management of Pleural Effusions
Hi. I'm Mark Kris from Memorial Sloan-Kettering Cancer Center in New York. What I'd like to talk about today is the management of pleural effusions, and I'd like to talk specifically about a paper that was presented at the annual meeting of the American Society of Clinical Oncology in Chicago back in June. This paper was the report of a group of patients who were treated as part of a large clinical trial led by Todd Deming from Roselle Park and sponsored by the Cancer and Leukemia Group B. What they did in this trial was take patients, primarily with lung and breast cancer, and randomize them to have small-catheter continuous drainage, so-called PleurX [CareFusion, San Diego, California] drainage, vs the standard hospitalization and tube thoracoscopy and talc pleurodesis.
Many of us have been impressed by how effective the small-tube drainage is, how it gives good palliation, how it results in much less pain and fewer side effects, particularly very serious side effects like respiratory distress, which can accompany the use of a talc pleurodesis in a chest tube. Also it is much better, in my estimation, for patients in that it is an outpatient procedure. People typically spend 1 night or no nights in the hospital. More importantly, we're never in that situation where the lung is not re-expanded, the drainage has been a little high, and the tube needs to stay in another day and another day and another day. For many of us, people with 2 thoracoscopies are in the hospital for 3, 5, 7, even 8 days. It's a very difficult time, painful because the tube is in there and very, very hard. I have found that the small-tube, pleural fluid drainage with the PleurX catheter, gets around that and becomes more tolerable and in many ways more effective.
That is exactly what that Demmy paper showed. For the hard endpoint, people whose lungs were successfully treated with no recurrence of effusion or death in the 30 days after the tubes were inserted, there was a huge difference. Death or recurrence occurred in 18% of the small-tube group vs 47% of the standard-tube thoracoscopy group.
So, when I have a patient with a symptomatic pleural effusion that requires drainage, my preferred method now is to use small-tube thoracoscopy, the PleurX type catheter. In our institution they are inserted by pulmonary physicians, thoracic surgeons, and interventional radiologists. Many physicians have that skill. It is much easier for the individual patients. Based on the Deming data, the PleurX gives you much better control and much less morbidity and mortality than the tube thoracoscopy. I find it a much better procedure and one that I would highly recommend and ask you to consider the next time you have a patient with a symptomatic pleural effusion.
Hi. I'm Mark Kris from Memorial Sloan-Kettering Cancer Center in New York. What I'd like to talk about today is the management of pleural effusions, and I'd like to talk specifically about a paper that was presented at the annual meeting of the American Society of Clinical Oncology in Chicago back in June. This paper was the report of a group of patients who were treated as part of a large clinical trial led by Todd Deming from Roselle Park and sponsored by the Cancer and Leukemia Group B. What they did in this trial was take patients, primarily with lung and breast cancer, and randomize them to have small-catheter continuous drainage, so-called PleurX [CareFusion, San Diego, California] drainage, vs the standard hospitalization and tube thoracoscopy and talc pleurodesis.
Many of us have been impressed by how effective the small-tube drainage is, how it gives good palliation, how it results in much less pain and fewer side effects, particularly very serious side effects like respiratory distress, which can accompany the use of a talc pleurodesis in a chest tube. Also it is much better, in my estimation, for patients in that it is an outpatient procedure. People typically spend 1 night or no nights in the hospital. More importantly, we're never in that situation where the lung is not re-expanded, the drainage has been a little high, and the tube needs to stay in another day and another day and another day. For many of us, people with 2 thoracoscopies are in the hospital for 3, 5, 7, even 8 days. It's a very difficult time, painful because the tube is in there and very, very hard. I have found that the small-tube, pleural fluid drainage with the PleurX catheter, gets around that and becomes more tolerable and in many ways more effective.
That is exactly what that Demmy paper showed. For the hard endpoint, people whose lungs were successfully treated with no recurrence of effusion or death in the 30 days after the tubes were inserted, there was a huge difference. Death or recurrence occurred in 18% of the small-tube group vs 47% of the standard-tube thoracoscopy group.
So, when I have a patient with a symptomatic pleural effusion that requires drainage, my preferred method now is to use small-tube thoracoscopy, the PleurX type catheter. In our institution they are inserted by pulmonary physicians, thoracic surgeons, and interventional radiologists. Many physicians have that skill. It is much easier for the individual patients. Based on the Deming data, the PleurX gives you much better control and much less morbidity and mortality than the tube thoracoscopy. I find it a much better procedure and one that I would highly recommend and ask you to consider the next time you have a patient with a symptomatic pleural effusion.