title: Patient evaluation for rapid pleurodesis of malignant pleural effusions.
abstract: BACKGROUND
  Malignant pleural effusions (MPEs) represent advanced stage disease with potentially significant patient discomfort due to dyspnea. Palliative management options include repetitive thoracenteses, placement of a tunneled pleural catheter (TPC), chemical pleurodesis, or some combination of these procedures. The rapid pleurodesis procedure combines thoracoscopic talc pleurodesis and insertion of a TPC at the same time with the goals of reducing both the length of hospitalization and the duration of catheter use. The rapid pleurodesis procedure has previously been described to achieve both of these goals in a pilot study of 30 patients with fully expandable lungs. Both symptoms of dyspnea and quality of life improved with few complications. Additional data on procedural effectiveness is needed to optimize patient selection for this procedure.
  
  
  METHODS
  We performed a retrospective analysis of patients who had undergone rapid pleurodesis protocol at two academic institutions over a 40-month period. Data was collected and analyzed on time to removal of the TPC, chemotherapy, malignancy type, complications, age, and catheter occlusion.
  
  
  RESULTS
  A total of 29 patients underwent the rapid pleurodesis protocol with a median hospital length of stay of 2 days. Total length of hospitalization was not significantly different between patients with and without primary lung cancer. Median duration of the indwelling TPC was 10 days. Patients with primary lung cancer and those actively or recently undergoing chemotherapy maintained the catheter longer than their counterparts.
  
  
  CONCLUSIONS
  The rapid pleurodesis protocol should be considered a viable treatment option for select patients with symptomatic recurrent MPEs undergoing chemical pleurodesis.
authors.affiliation: Division of Pulmonary and Critical Care Medicine, University of Maryland Medical Center, Baltimore, USA.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Krochmal
authors.affiliation: Division of Pulmonary and Critical Care Medicine, University of Utah Health Sciences Center, Salt Lake City, USA.
authors.forename: Chakravarthy
authors.initials: C
authors.lastname: Reddy
authors.affiliation: Section of Interventional Pulmonology, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, USA.
authors.forename: Lonny
authors.initials: L
authors.lastname: Yarmus
authors.affiliation: Chicago Chest Center, Elk Grove Village, USA.
authors.forename: Neeraj R
authors.initials: NR
authors.lastname: Desai
authors.affiliation: Section of Interventional Pulmonology, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, USA.
authors.forename: David
authors.initials: D
authors.lastname: Feller-Kopman
authors.affiliation: Section of Interventional Pulmonology, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, USA.
authors.forename: Hans J
authors.initials: HJ
authors.lastname: Lee
keywords: Malignant pleural effusion (MPE); pleurodesis; tunneled pleural catheter (TPC)