title: Randomized Trial of Pleural Fluid Drainage Frequency in Patients with Malignant Pleural Effusions. The ASAP Trial.
abstract: BACKGROUND
  Patients with malignant pleural effusions have significant dyspnea and shortened life expectancy. Indwelling pleural catheters allow patients to drain pleural fluid at home and can lead to autopleurodesis. The optimal drainage frequency to achieve autopleurodesis and freedom from catheter has not been determined.
  
  
  OBJECTIVE
  To determine whether an aggressive daily drainage strategy is superior to the current standard every other day drainage of pleural fluid in achieving autopleurodesis.
  
  
  METHODS
  Patients were randomized to either an aggressive drainage (daily drainage; n = 73) or standard drainage (every other day drainage; n = 76) of pleural fluid via a tunneled pleural catheter.
  
  
  RESULTS
  The primary outcome was the incidence of autopleurodesis following the placement of the indwelling pleural catheters. The rate of autopleurodesis, defined as complete or partial response based on symptomatic and radiographic changes, was greater in the aggressive drainage arm than the standard drainage arm (47% vs. 24%, respectively; P = 0.003). Median time to autopleurodesis was shorter in the aggressive arm (54 d; 95% confidence interval, 34-83) as compared with the standard arm (90 d; 95% confidence interval, 70 to nonestimable). Rate of adverse events, quality of life, and patient satisfaction were not significantly different between the two arms.
  
  
  CONCLUSIONS
  Among patients with malignant pleural effusion, daily drainage of pleural fluid via an indwelling pleural catheter led to a higher rate of autopleurodesis and faster time to liberty from catheter. Clinical trial registered with www.clinicaltrials.gov (NCT 00978939).
authors.affiliation: 1 Division of Pulmonary Medicine, Department of Medicine, Duke University, Durham, North Carolina.
authors.forename: Momen M
authors.initials: MM
authors.lastname: Wahidi
authors.affiliation: 2 University of Utah, Salt Lake City, Utah.
authors.forename: Chakravarthy
authors.initials: C
authors.lastname: Reddy
authors.affiliation: 3 Johns Hopkins University, Baltimore, Maryland.
authors.forename: Lonny
authors.initials: L
authors.lastname: Yarmus
authors.affiliation: 3 Johns Hopkins University, Baltimore, Maryland.
authors.forename: David
authors.initials: D
authors.lastname: Feller-Kopman
authors.affiliation: 4 Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Ali
authors.initials: A
authors.lastname: Musani
authors.affiliation: 5 Virginia Commonwealth University, Richmond, Virginia.
authors.forename: R Wesley
authors.initials: RW
authors.lastname: Shepherd
authors.affiliation: 3 Johns Hopkins University, Baltimore, Maryland.
authors.forename: Hans
authors.initials: H
authors.lastname: Lee
authors.affiliation: 6 Cancer Treatment Centers of America/Southeastern, Newnan, Georgia.
authors.forename: Rabih
authors.initials: R
authors.lastname: Bechara
authors.affiliation: 7 Lahey Hospital and Medical Center, Burlington, Massachusetts.
authors.forename: Carla
authors.initials: C
authors.lastname: Lamb
authors.affiliation: 1 Division of Pulmonary Medicine, Department of Medicine, Duke University, Durham, North Carolina.
authors.forename: Scott
authors.initials: S
authors.lastname: Shofer
authors.affiliation: 1 Division of Pulmonary Medicine, Department of Medicine, Duke University, Durham, North Carolina.
authors.forename: Kamran
authors.initials: K
authors.lastname: Mahmood
authors.affiliation: 8 New York University, New York, New York.
authors.forename: Gaetane
authors.initials: G
authors.lastname: Michaud
authors.affiliation: 9 Yale University, New Haven, Connecticut.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Puchalski
authors.affiliation: 10 Saint Elizabeth Medical Center, Boston, Massachusetts.
authors.forename: Samaan
authors.initials: S
authors.lastname: Rafeq
authors.affiliation: 11 Division of Thoracic Surgery, Department of Surgery, Anne Arundel Health System, Annapolis, Maryland.
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Cattaneo
authors.affiliation: 12 Mayo Clinic, Rochester, Minnesota.
authors.forename: John
authors.initials: J
authors.lastname: Mullon
authors.affiliation: 13 Aurora Saint Luke's Medical Center, Milwaukee, Wisconsin.
authors.forename: Steven
authors.initials: S
authors.lastname: Leh
authors.affiliation: 14 Holaira, Inc., Minneapolis, Minnesota.
authors.forename: Martin
authors.initials: M
authors.lastname: Mayse
authors.affiliation: 15 Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina; and.
authors.forename: Samantha M
authors.initials: SM
authors.lastname: Thomas
authors.affiliation: 15 Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina; and.
authors.forename: Bercedis
authors.initials: B
authors.lastname: Peterson
authors.affiliation: 16 Vanderbilt University, Nashville, Tennessee.
authors.forename: Richard W
authors.initials: RW
authors.lastname: Light
mesh_terms: D002408:Catheters, Indwelling; D004322:Drainage / Q000295:instrumentation / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D016066:Pleural Effusion, Malignant / Q000628:therapy*; D011788:Quality of Life; D012008:Recurrence; D016037:Single-Blind Method; D011795:Surveys and Questionnaires; D013997:Time Factors
keywords: indwelling pleural catheter; malignant pleural effusions; pleurodesis