Pleurodesis for effusions in pediatric oncology patients at end of life.
BACKGROUND
Pleurodesis for end-of-life care has been used in adults for decades, but little is known about the usefulness of this technique in improving the quality of care for pediatric patients.


OBJECTIVE
To assess whether intractable pleural effusions in pediatric oncology patients at end of life could be sufficiently relieved by pleurodesis.


METHODS
Eleven pleurodeses were performed with doxycycline in seven pediatric cancer patients (age 3-21 years) with intractable pleural effusions at the end of life. Five patients had unilateral pleurodeses and two had a unilateral followed by bilateral pleurodeses.


RESULTS
Respiratory rates decreased in all seven patients (P = 0.016) and aeration improved significantly after chest tube placement (P = 0.033). The chest tubes were placed a median of 1 day before pleurodesis. Eight of nine chest tubes (89%) were removed before discharge at a median of 3 days after pleurodesis. Pain secondary to the pleurodesis lasted 1 day or less. Improvement in the respiratory rate remained after pleurodesis and chest tube removal (P = 0.031). Five of seven patients (70%) were able to leave the hospital to return home. The five patients discharged lived 10 to 49 days (median 19 days) after discharge.


CONCLUSIONS
Pediatric oncology patients with intractable effusions at end of life can have respiratory benefit from pleurodeses and, as a result, are more likely to return home for terminal care.
Hoffer
Fredric A
FA
Department of Radiological Sciences, St. Jude Children's Research Hospital, Memphis, TN, USA. fred.hoffer@seattlechildrens.org
Hancock
Michael L
ML
Hinds
Pamela S
PS
Oigbokie
Nikita
N
Rai
Shesh N
SN
Rao
Bhaskar
B
D000293:Adolescent; D000328:Adult; D015505:Chest Tubes; D002648:Child; D002675:Child, Preschool; D020878:Device Removal; D004318:Doxycycline / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000628:therapy*; D010101:Oxygen Consumption / Q000502:physiology; D010166:Palliative Care; D010351:Patient Discharge; D016066:Pleural Effusion, Malignant / Q000188:drug therapy*; D018700:Pleurodesis; D012119:Respiration; D012189:Retrospective Studies; D015996:Survival Rate; D013727:Terminal Care
D004318:Doxycycline