title: Effectiveness and safety of outpatient pleurodesis in patients with recurrent malignant pleural effusion and low performance status.
abstract: OBJECTIVE
  To evaluate the effectiveness and safety of pleurodesis carried out entirely on an outpatient basis in patients with recurrent malignant pleural effusions and Karnofsky Performance Status scores <70.
  
  
  METHODS
  This study was a prospective trial comprising patients with symptomatic recurrent malignant pleural effusion and Karnofsky Performance Status scores <70 but >30. All selected patients underwent pleural catheter placement (14 Fr) in an outpatient facility. When chest radiography revealed post-drainage lung expansion of >90%, pleurodesis (3 g of talc) was performed. Catheters were maintained until the daily output was ,100 mL/day. The patients were evaluated in the first month and every three months thereafter for fluid recurrence, the need for additional procedures, and complications.
  
  
  RESULTS
  During the study period (January 2005 to July 2007), 64 patients (24 men, 40 women), with an average age of 61.4 years, underwent elective chest tube drainage. Primary sites of the underlying malignancy were breast (27), lung (22), and others (15). Sixty-six pleural catheters were placed (bilaterally in 2 patients), and 52 talc pleurodesis procedures were performed. Fourteen patients had a trapped lung and were excluded from the trial. No complications were observed during catheter placement or pleurodesis. Post-pleurodesis complications included catheter obstruction (4 patients) and empyema (1). The average drainage time was 9.9 days. The recurrence rate observed in patients that were alive 30 days after pleurodesis was 13.9% (5/36 patients). Six patients required additional procedures after the pleurodesis. The average survival time was 101 days.
  
  
  CONCLUSIONS
  In this study, talc pleurodesis was safely performed in an outpatient setting with good efficacy and a reasonable complication rate, thereby avoiding hospital admission.
authors.affiliation: Thoracic Surgery Division, Hospital das Clínicas, Faculdade de Mecicina, Universidade de São Paulo, São Paulo, Brazil. rmterra@uol.com.br
authors.forename: Ricardo Mingarini
authors.initials: RM
authors.lastname: Terra
authors.forename: Lisete Ribeiro
authors.initials: LR
authors.lastname: Teixeira
authors.forename: Benoit Jacques
authors.initials: BJ
authors.lastname: Bibas
authors.forename: Paulo Manuel
authors.initials: PM
authors.lastname: Pego-Fernandes
authors.forename: Francisco Suso
authors.initials: FS
authors.lastname: Vargas
authors.forename: Fabio Biscegli
authors.initials: FB
authors.lastname: Jatene
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000554:Ambulatory Care Facilities; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D017567:Karnofsky Performance Status; D008297:Male; D008875:Middle Aged; D016066:Pleural Effusion, Malignant / Q000628:therapy*; D018700:Pleurodesis / Q000009:adverse effects* / Q000379:methods; D011446:Prospective Studies; D012008:Recurrence; D013627:Talc / Q000008:administration & dosage; D016896:Treatment Outcome
chemical_list: D013627:Talc