Rapid pleurodesis with doxycycline through a small-bore catheter for the treatment of metastatic malignant effusions.
OBJECTIVE
The goal of the study was to evaluate the safety and efficacy of bedside pleurodesis with doxycycline using a short-term indwelling chest catheter for the palliative treatment of malignant effusions.


METHODS
A prospective study of 36 rapid pleurodesis procedures in 34 patients with malignant pleural effusions was conducted over a 5-year period in a university hospital. A 12F chest catheter placement was facilitated utilizing the Seldinger percutaneous entry technique. Patients received 500 mg of intrapleural doxycycline combined in half of the cases with mepivacaine. We assessed success or failure of pleurodesis in addition to the frequency of complications and survival.


RESULTS
Chest tubes were removed within 24 h in 69% and within 48 h in 94% of the patients. Complete success of pleurodesis was achieved in 17 (55%), partial success in eight (26%), and failure in six (19%) out of 31 evaluative procedures. Thus, the overall success rate of pleurodesis was 81%. Toxicity was mild and included pain (36%), fever (8%), and pneumothorax (6%). The median survival was 105 days. There was no relationship between instillation of intrapleural anesthetics and development of pain.


CONCLUSIONS
Rapid pleurodesis with doxycycline, which can be accomplished within 24 to 48 h, is a valid option for the symptomatic treatment of malignant effusions. This technique can be used as a first-line procedure in the majority of cases, particularly if thoracoscopic facilities are not available.
Porcel
José Manuel
JM
Department of Internal Medicine, Arnau de Vilanova University Hospital, Lleida, Spain. jporcelp@yahoo.es
Salud
Antonieta
A
Nabal
Maria
M
Vives
Manuel
M
Esquerda
Aureli
A
Rodríguez-Panadero
Francisco
F
D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D002408:Catheters, Indwelling; D015505:Chest Tubes; D004318:Doxycycline / Q000008:administration & dosage* / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications*; D010166:Palliative Care; D010996:Pleural Effusion / Q000209:etiology / Q000628:therapy*; D018700:Pleurodesis / Q000379:methods*; D011446:Prospective Studies; D013997:Time Factors
D000900:Anti-Bacterial Agents; D004318:Doxycycline