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N M Rahman - One of the best experts on this subject based on the ideXlab platform.
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survival and Pleurodesis outcome in patients with malignant pleural effusion a systematic review
Pleura and Peritoneum, 2021Co-Authors: Maged Hassan, Rachel Mercer, Elinor Harriss, N M RahmanAbstract:© 2021 Maged Hassan et al., published by De Gruyter, Berlin/Boston 2021. Malignant pleural effusion (MPE) is a common condition that presents with progressive breathlessness. Long term solutions are often required due to recurrence of effusion after simple drainage. Pleurodesis is one of the main options resorted to for long term control of MPE. There is data to suggest there may be a survival benefit for patients with MPE who achieve successful Pleurodesis. A systematic review was carried out to explore this correlation and results suggest that there could be a survival difference according to Pleurodesis outcome in patients with MPE. Fifteen studies (reported in 13 papers) were included; 13 (86.6%) of the studies showed survival difference in favour of Pleurodesis success. The median [interquartile range] difference in survival between the two groups among the different studies was five [3.5-5.8] months. Most of the included studies suffered moderate to severe risk of bias and, thus, large prospective studies of patients undergoing Pleurodesis are required to ascertain this effect.
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predictors of outcome of Pleurodesis in patients with malignant pleural effusion a systematic review and meta analysis
Expert Review of Respiratory Medicine, 2020Co-Authors: Maged Hassan, Mohamed G E Gadallah, Rachel Mercer, Elinor Harriss, N M RahmanAbstract:Objectives: Pleurodesis is an important management option to palliate breathlessness in patients with malignant pleural effusion (MPE). This systematic review aimed to examine available literature for studies investigating factors that predict Pleurodesis outcome.Methods: The healthcare databases advanced search (HDAS) Medline and Embase in addition to Cochrane Database of Systematic Reviews were searched on for publications reporting on Pleurodesis for MPE in English language. All study types reporting previously unpublished data on predictors of Pleurodesis success were included. Thirty-four studies involving 4626 patients were included in the systematic review.Results: The most common Pleurodesis agent used was talc which was used in 27 studies. Meta-analyses demonstrated that the strongest predictors of Pleurodesis success were higher pleural fluid pH, smaller volume of effusion pre-Pleurodesis and full lung re-expansion post effusion drainage. Shorter duration of tube drainage, higher pleural fluid glucose, lower LDH, and lower pleural tumor burden all seem to favor Pleurodesis success, but with considerable statistical heterogeneity between studies. Available data do not suggest that chest tube size affects Pleurodesis outcome.Conclusion: Overall, available results are difficult to interpret due to evidence quality. Prospective studies are needed to further explore these factors.Protocol registration: CRD42018115874 (Prospero database of systematic reviews).
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Multidisciplinary approaches to the management of malignant pleural effusions: a guide for the clinician
Taylor and Francis, 2020Co-Authors: N M Rahman, Banka RAbstract:INTRODUCTION: Malignant pleural effusion (MPE) is a complication of advanced cancer, associated with significant mortality and morbidity. This entity is commonly treated by respiratory physicians, oncologists, and thoracic surgeons. There have been various randomized clinical trials assessing the relative merits of chest drain Pleurodesis, indwelling pleural catheters, treatment of septated MPEs, the use of thoracoscopy and Pleurodesis and Pleurodesis through IPCs in the past decade which have addressed some key areas in the management of MPEs, with an increasing focus on patient related outcome. AREAS COVERED: In this review, we examine and review the literature for management strategies for MPEs and discuss future directions. A detailed search of scientific literature and clinical trial registries published in the past two decades was undertaken. EXPERT OPINION: Tremendous progress has been made in management of MPE in the past decade and current strategy involves patient preference along with local expertise that is available.
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thoracic ultrasound as an early predictor of Pleurodesis success in malignant pleural effusion
Chest, 2018Co-Authors: John P Corcoran, Maged Hassan, Rachel Mercer, Rj Hallifax, A Yousuf, Rachelle Asciak, Hania E G Piotrowska, Ioannis Psallidas, N M RahmanAbstract:Background Malignant pleural effusion (MPE) is common and imposes a significant burden on patients and health-care providers. Most patients require definitive treatment, usually drainage and chemical Pleurodesis, to relieve symptoms and prevent fluid recurrence. Thoracic ultrasound (TUS) can identify the presence of pleural adhesions in other clinical scenarios, and could therefore have a role in predicting long-term Pleurodesis success or failure in MPE. Methods Patients undergoing chest tube drainage and talc slurry Pleurodesis for symptomatic MPE were recruited to a prospective observational cohort pilot study assessing whether TUS findings pre-talc and post-talc instillation predicted treatment outcome. Participants underwent TUS examination immediately before, and 24 h after talc slurry administration to derive pleural adherence scores for the affected hemithorax. The recorded TUS scans were additionally scored by two independent assessors blinded to the patient’s clinical status. The primary outcome was Pleurodesis success at 1-month and 3-month follow-up. Results Eighteen participants were recruited to the pilot study. Participants who suffered Pleurodesis failure had a lower pleural adherence score at 24 h post-talc instillation than those who were successful (difference of 6.27; 95% CI, 3.94-8.59). TUS examination was acceptable to patients, while TUS scoring was highly consistent across all assessors (intraclass correlation coefficient, 0.762; 95% CI, 0.605-0.872). Conclusion A TUS-derived pleural adherence score may facilitate early prediction of long-term outcomes following chemical Pleurodesis, with implications for personalized care and decision making in MPE. Further research is needed to evaluate this novel finding. Trial Registry ClinicalTrials.gov; No. NCT02625675 ; URL: www.clinicaltrials.gov .
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The role of Pleurodesis in respiratory diseases.
'Informa UK Limited', 2018Co-Authors: Rm Mercer, Hassan M, N M RahmanAbstract:Introduction Pleurodesis is used to obliterate the pleural space, most commonly in patients with symptomatic malignant pleural effusions but also in patients with benign effusions or pneumothorax. Areas covered Traditionally, chemical Pleurodesis has been undertaken at thoracoscopy or using instillation of a slurry through a chest drain. The optimum method of achieving Pleurodesis, whether surgical or medical, has yet to be proven. Evidence in the different disease areas will be reviewed, along with ongoing trial evidence, which may change practice. Expert commentary Newer methods of achieving Pleurodesis are being introduced. Studies have shown that instilling sclerosing agents via an indwelling pleural catheter or introducing drug-eluting catheters are safe and effective ways of inducing Pleurodesis. There is evidence that Pleurodesis might increase in survival, especially after pleural infection, possibly due to activation of the immune system. Multiple studies are currently underway to answer some of these questions and the future landscape may be very different from the present.
Eleanor K Mishra - One of the best experts on this subject based on the ideXlab platform.
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randomized controlled trial of urokinase versus placebo for nondraining malignant pleural effusion
American Journal of Respiratory and Critical Care Medicine, 2017Co-Authors: Eleanor K Mishra, Amelia O Clive, G Wills, Helen E Davies, Andrew Stanton, M Alaloul, Alan Hartthomas, Justin Pepperell, M Evison, Tarek SabaAbstract:Rationale: Patients with malignant pleural effusion experience breathlessness, which is treated by drainage and Pleurodesis. Incomplete drainage results in residual dyspnea and Pleurodesis failure....
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comparing cost of indwelling pleural catheter vs talc Pleurodesis for malignant pleural effusion
Chest, 2014Co-Authors: Erika Penz, Eleanor K Mishra, Helen E Davies, Braden J Manns, R F Miller, N M RahmanAbstract:BACKGROUND Malignant pleural effusion is associated with short life expectancy and significant morbidity. A randomized controlled trial comparing indwelling pleural catheters (IPCs) with talc Pleurodesis found that IPCs reduced in-hospital time and the need for additional procedures but were associated with excess adverse events. METHODS Using data from the clinical trial, we compared costs associated with use of IPCs and with talc Pleurodesis. Resource use and adverse events were captured through case report forms over the 1-year trial follow-up. Costs for outpatient and inpatient visits, diagnostic imaging, nursing, and doctor time were obtained from the UK National Health Service reference costs and University of Kent's Unit Costs of Health and Social Care 2011 and inflated to 2013 using the UK Consumer Price Index. Procedure supply costs were obtained from the manufacturer. Difference in mean costs was compared using nonparametric bootstrapping. All costs were converted to US dollars using the Organisation for Economic Co-operation and Development Purchasing Power Parity Index. RESULTS Overall mean cost (SD) for managing patients with IPCs and talc Pleurodesis was $4,993 ($5,529) and $4,581 ($4,359), respectively. The incremental mean cost difference was $401, with 95% CI of −$1,387 to $2,261. The mean cost related to ongoing drainage in the IPC group was $1,011 ($732) vs $57 ($213) in the talc Pleurodesis group (P = .001). This included the cost of drainage bottles, dressing changes in the first month, and catheter removal. There was no significant difference in cost of the initial intervention or adverse events between the groups. For patients with survival CONCLUSIONS There is no significant difference in the mean cost of managing patients with IPCs compared with talc Pleurodesis. For patients with limited survival, IPC appears less costly. TRIAL REGISTRY isrctn.org; No.: ISRCTN87514420; URL: www.isrctn.org
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s79 comparing the quality of life and cost effectiveness of indwelling pleural catheter vs talc Pleurodesis for malignant pleural effusions
Thorax, 2013Co-Authors: Erika Penz, Eleanor K Mishra, Helen E Davies, Braden J Manns, R F Miller, N M RahmanAbstract:Background The TIME2 Trial[1], a randomised clinical trial comparing indwelling pleural catheter (IPC) with talc Pleurodesis for malignant pleural effusion, included a prospective economic analysis. Methods 106 patients at 7 UK medical centres were randomly assigned to IPC or talc Pleurodesis following chest drain insertion and followed at biweekly, monthly and q3month intervals for one year or until death. Costs associated with the drain insertion, follow up drainage, and adverse events were captured during the trial. Costs for outpatient and inpatient visits, diagnostic imaging, nursing and doctor time were derived from the NHS reference costs and University of Kent’s Unit Costs of Health and Social Care 2011. Procedure supply costs were obtained from the manufacturer. The number of quality adjusted life years (QALYs) was determined by adjusting patient survival by the utility weight obtained from the EQ5D questionnaire at each follow up period. Cost effectiveness was calculated over the duration of the trial given that most patients died during the 1 year follow up (14% alive at 1 year). Confidence intervals were calculated using bootstrap analysis. Results Average cost in the IPC group over the trial period was £3087(3504) versus £2892(2706) in the talc Pleurodesis group with a mean cost difference of £195(95% CI -1072 to 1463). Average QALY in the IPC group was 0.354(0.29) and 0.328(0.3) in the talc group with a mean QALY difference between groups of 0.026 (95%CI -.08 to. 138). The cost per QALY gained for IPC as compared with talc Pleurodesis was £7390 at 1 year. Bootstrap analysis revealed substantial uncertainty around this estimate. Conclusions There is no significant difference in cost or QALYs between IPCs and talc Pleurodesis. Although the predictions are subject to substantial uncertainty, the probability that IPCs may be cost effective compared with talc Pleurodesis is moderately high (60%) using a threshold of willingness to pay of £20,000/QALY. References Davies H, Mishra E, Kahan B, et al. Effect of an Indwelling Pleural Catheter vs. Chest Tube and Talc Pleurodesis for Relieving Dyspnea in Patients with Malignant Pleural Effusion. The TIME2 Randomised Controlled Trial. JAMA. 2012;307(22): 2383–2389.
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s79 comparing the quality of life and cost effectiveness of indwelling pleural catheter vs talc Pleurodesis for malignant pleural effusions
Thorax, 2013Co-Authors: Erika Penz, Eleanor K Mishra, Helen E Davies, Braden J Manns, R F Miller, N M RahmanAbstract:Background The TIME2 Trial[1], a randomised clinical trial comparing indwelling pleural catheter (IPC) with talc Pleurodesis for malignant pleural effusion, included a prospective economic analysis. View this table: Abstract S78 Table 1. Estimates of income using old and new tariffs based on yearly patient numbers and audit data Methods 106 patients at 7 UK medical centres were randomly assigned to IPC or talc Pleurodesis following chest drain insertion and followed at biweekly, monthly and q3month intervals for one year or until death. Costs associated with the drain insertion, follow up drainage, and adverse events were captured during the trial. Costs for outpatient and inpatient visits, diagnostic imaging, nursing and doctor time were derived from the NHS reference costs and University of Kent’s Unit Costs of Health and Social Care 2011. Procedure supply costs were obtained from the manufacturer. The number of quality adjusted life years (QALYs) was determined by adjusting patient survival by the utility weight obtained from the EQ5D questionnaire at each follow up period. Cost effectiveness was calculated over the duration of the trial given that most patients died during the 1 year follow up (14% alive at 1 year). Confidence intervals were calculated using bootstrap analysis. Results Average cost in the IPC group over the trial period was £3087(3504) versus £2892(2706) in the talc Pleurodesis group with a mean cost difference of £195(95% CI -1072 to 1463). Average QALY in the IPC group was 0.354(0.29) and 0.328(0.3) in the talc group with a mean QALY difference between groups of 0.026 (95%CI -.08 to. 138). The cost per QALY gained for IPC as compared with talc Pleurodesis was £7390 at 1 year. Bootstrap analysis revealed substantial uncertainty around this estimate. Conclusions There is no significant difference in cost or QALYs between IPCs and talc Pleurodesis. Although the predictions are subject to substantial uncertainty, the probability that IPCs may be cost effective compared with talc Pleurodesis is moderately high (60%) using a threshold of willingness to pay of £20,000/QALY. ![Abstract S79 Figure 1.][1] Abstract S79 Figure 1. References 1. Davies H, Mishra E, Kahan B, et al . Effect of an Indwelling Pleural Catheter vs. Chest Tube and Talc Pleurodesis for Relieving Dyspnea in Patients with Malignant Pleural Effusion. The TIME2 Randomised Controlled Trial. JAMA . 2012;307(22): 2383–2389. [1]: pending:yes
Aman S Coonar - One of the best experts on this subject based on the ideXlab platform.
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efficacy and cost of video assisted thoracoscopic partial pleurectomy versus talc Pleurodesis in patients with malignant pleural mesothelioma mesovats an open label randomised controlled trial
The Lancet, 2014Co-Authors: Robert C Rintoul, Aman S Coonar, Andrew J Ritchie, John G Edwards, David A Waller, Maxine Bennett, Eleonora Lovato, V F Hughes, Julia Foxrushby, Linda D SharplesAbstract:Summary Background Malignant pleural mesothelioma incidence continues to rise, with few available evidence-based therapeutic options. Results of previous non-randomised studies suggested that video-assisted thoracoscopic partial pleurectomy (VAT-PP) might improve symptom control and survival. We aimed to compare efficacy in terms of overall survival, and cost, of VAT-PP and talc Pleurodesis in patients with malignant pleural mesothelioma. Methods We undertook an open-label, parallel-group, randomised, controlled trial in patients aged 18 years or older with any subtype of confirmed or suspected mesothelioma with pleural effusion, recruited from 12 hospitals in the UK. Eligible patients were randomly assigned (1:1) to either VAT-PP or talc Pleurodesis by computer-generated random numbers, stratified by European Organisation for Research and Treatment of Cancer risk category (high vs low). The primary outcome was overall survival at 1 year, analysed by intention to treat (all patients randomly assigned to a treatment group with a final diagnosis of mesothelioma). This trial is registered with ClinicalTrials.gov, number NCT00821860. Findings Between Oct 24, 2003, and Jan 24, 2012, we randomly assigned 196 patients, of whom 175 (88 assigned to talc Pleurodesis, 87 assigned to VAT-PP) had confirmed mesothelioma. Overall survival at 1 year was 52% (95% CI 41–62) in the VAT-PP group and 57% (46–66) in the talc Pleurodesis group (hazard ratio 1·04 [95% CI 0·76–1·42]; p=0·81). Surgical complications were significantly more common after VAT-PP than after talc Pleurodesis, occurring in 24 (31%) of 78 patients who completed VAT-PP versus ten (14%) of 73 patients who completed talc Pleurodesis (p=0·019), as were respiratory complications (19 [24%] vs 11 [15%]; p=0·22) and air-leak beyond 10 days (five [6%] vs one [1%]; p=0·21), although not significantly so. Median hospital stay was longer at 7 days (IQR 5–11) in patients who received VAT-PP compared with 3 days (2–5) for those who received talc Pleurodesis (p Interpretation VAT-PP is not recommended to improve overall survival in patients with pleural effusion due to malignant pleural mesothelioma, and talc Pleurodesis might be preferable considering the fewer complications and shorter hospital stay associated with this treatment. Funding BUPA Foundation.
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a prospective study of autologous blood patch Pleurodesis for persistent air leak after pulmonary resection
European Journal of Cardio-Thoracic Surgery, 2004Co-Authors: Loo C Langlazdunski, Aman S CoonarAbstract:Objective: To evaluate the efficacy and risks of autologous ‘blood patch’ Pleurodesis in patients with persistent air leak after pulmonary resection. Methods: All patients operated on by a single surgeon between January 2002 and January 2004 and presenting with a persistent air leak after pulmonary resection have been treated by the autologous blood patch Pleurodesis technique. Fifty millilitres of autologous blood were injected through the chest tube that was then rinsed, clamped for 30 min and then unclamped and placed back to water seal. Results :W e have obtained a 100% success rate in 11 patients with persistent air leak who have been treated with this technique over a 2-year period. Most air leaks (72.7%) ceased within 12 h of blood injection. No patient developed empyema, but two patients developed fever and pleural fluid grew Staphylococcus after blood Pleurodesis. At 3-month follow-up, all patients were well and their lungs were expanded fully. Conclusions: In our experience a single injection of 50 ml of blood is sufficient to seal persistent air leaks in less than 48 h. Although highly effective, the autologous blood patch Pleurodesis technique should not be used in patients with incomplete lung re-expansion or positive pleural fluid culture to minimize the risk of empyema. q 2004 Elsevier B.V. All rights reserved.
Helen E Davies - One of the best experts on this subject based on the ideXlab platform.
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randomized controlled trial of urokinase versus placebo for nondraining malignant pleural effusion
American Journal of Respiratory and Critical Care Medicine, 2017Co-Authors: Eleanor K Mishra, Amelia O Clive, G Wills, Helen E Davies, Andrew Stanton, M Alaloul, Alan Hartthomas, Justin Pepperell, M Evison, Tarek SabaAbstract:Rationale: Patients with malignant pleural effusion experience breathlessness, which is treated by drainage and Pleurodesis. Incomplete drainage results in residual dyspnea and Pleurodesis failure....
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comparing cost of indwelling pleural catheter vs talc Pleurodesis for malignant pleural effusion
Chest, 2014Co-Authors: Erika Penz, Eleanor K Mishra, Helen E Davies, Braden J Manns, R F Miller, N M RahmanAbstract:BACKGROUND Malignant pleural effusion is associated with short life expectancy and significant morbidity. A randomized controlled trial comparing indwelling pleural catheters (IPCs) with talc Pleurodesis found that IPCs reduced in-hospital time and the need for additional procedures but were associated with excess adverse events. METHODS Using data from the clinical trial, we compared costs associated with use of IPCs and with talc Pleurodesis. Resource use and adverse events were captured through case report forms over the 1-year trial follow-up. Costs for outpatient and inpatient visits, diagnostic imaging, nursing, and doctor time were obtained from the UK National Health Service reference costs and University of Kent's Unit Costs of Health and Social Care 2011 and inflated to 2013 using the UK Consumer Price Index. Procedure supply costs were obtained from the manufacturer. Difference in mean costs was compared using nonparametric bootstrapping. All costs were converted to US dollars using the Organisation for Economic Co-operation and Development Purchasing Power Parity Index. RESULTS Overall mean cost (SD) for managing patients with IPCs and talc Pleurodesis was $4,993 ($5,529) and $4,581 ($4,359), respectively. The incremental mean cost difference was $401, with 95% CI of −$1,387 to $2,261. The mean cost related to ongoing drainage in the IPC group was $1,011 ($732) vs $57 ($213) in the talc Pleurodesis group (P = .001). This included the cost of drainage bottles, dressing changes in the first month, and catheter removal. There was no significant difference in cost of the initial intervention or adverse events between the groups. For patients with survival CONCLUSIONS There is no significant difference in the mean cost of managing patients with IPCs compared with talc Pleurodesis. For patients with limited survival, IPC appears less costly. TRIAL REGISTRY isrctn.org; No.: ISRCTN87514420; URL: www.isrctn.org
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s79 comparing the quality of life and cost effectiveness of indwelling pleural catheter vs talc Pleurodesis for malignant pleural effusions
Thorax, 2013Co-Authors: Erika Penz, Eleanor K Mishra, Helen E Davies, Braden J Manns, R F Miller, N M RahmanAbstract:Background The TIME2 Trial[1], a randomised clinical trial comparing indwelling pleural catheter (IPC) with talc Pleurodesis for malignant pleural effusion, included a prospective economic analysis. Methods 106 patients at 7 UK medical centres were randomly assigned to IPC or talc Pleurodesis following chest drain insertion and followed at biweekly, monthly and q3month intervals for one year or until death. Costs associated with the drain insertion, follow up drainage, and adverse events were captured during the trial. Costs for outpatient and inpatient visits, diagnostic imaging, nursing and doctor time were derived from the NHS reference costs and University of Kent’s Unit Costs of Health and Social Care 2011. Procedure supply costs were obtained from the manufacturer. The number of quality adjusted life years (QALYs) was determined by adjusting patient survival by the utility weight obtained from the EQ5D questionnaire at each follow up period. Cost effectiveness was calculated over the duration of the trial given that most patients died during the 1 year follow up (14% alive at 1 year). Confidence intervals were calculated using bootstrap analysis. Results Average cost in the IPC group over the trial period was £3087(3504) versus £2892(2706) in the talc Pleurodesis group with a mean cost difference of £195(95% CI -1072 to 1463). Average QALY in the IPC group was 0.354(0.29) and 0.328(0.3) in the talc group with a mean QALY difference between groups of 0.026 (95%CI -.08 to. 138). The cost per QALY gained for IPC as compared with talc Pleurodesis was £7390 at 1 year. Bootstrap analysis revealed substantial uncertainty around this estimate. Conclusions There is no significant difference in cost or QALYs between IPCs and talc Pleurodesis. Although the predictions are subject to substantial uncertainty, the probability that IPCs may be cost effective compared with talc Pleurodesis is moderately high (60%) using a threshold of willingness to pay of £20,000/QALY. References Davies H, Mishra E, Kahan B, et al. Effect of an Indwelling Pleural Catheter vs. Chest Tube and Talc Pleurodesis for Relieving Dyspnea in Patients with Malignant Pleural Effusion. The TIME2 Randomised Controlled Trial. JAMA. 2012;307(22): 2383–2389.
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s79 comparing the quality of life and cost effectiveness of indwelling pleural catheter vs talc Pleurodesis for malignant pleural effusions
Thorax, 2013Co-Authors: Erika Penz, Eleanor K Mishra, Helen E Davies, Braden J Manns, R F Miller, N M RahmanAbstract:Background The TIME2 Trial[1], a randomised clinical trial comparing indwelling pleural catheter (IPC) with talc Pleurodesis for malignant pleural effusion, included a prospective economic analysis. View this table: Abstract S78 Table 1. Estimates of income using old and new tariffs based on yearly patient numbers and audit data Methods 106 patients at 7 UK medical centres were randomly assigned to IPC or talc Pleurodesis following chest drain insertion and followed at biweekly, monthly and q3month intervals for one year or until death. Costs associated with the drain insertion, follow up drainage, and adverse events were captured during the trial. Costs for outpatient and inpatient visits, diagnostic imaging, nursing and doctor time were derived from the NHS reference costs and University of Kent’s Unit Costs of Health and Social Care 2011. Procedure supply costs were obtained from the manufacturer. The number of quality adjusted life years (QALYs) was determined by adjusting patient survival by the utility weight obtained from the EQ5D questionnaire at each follow up period. Cost effectiveness was calculated over the duration of the trial given that most patients died during the 1 year follow up (14% alive at 1 year). Confidence intervals were calculated using bootstrap analysis. Results Average cost in the IPC group over the trial period was £3087(3504) versus £2892(2706) in the talc Pleurodesis group with a mean cost difference of £195(95% CI -1072 to 1463). Average QALY in the IPC group was 0.354(0.29) and 0.328(0.3) in the talc group with a mean QALY difference between groups of 0.026 (95%CI -.08 to. 138). The cost per QALY gained for IPC as compared with talc Pleurodesis was £7390 at 1 year. Bootstrap analysis revealed substantial uncertainty around this estimate. Conclusions There is no significant difference in cost or QALYs between IPCs and talc Pleurodesis. Although the predictions are subject to substantial uncertainty, the probability that IPCs may be cost effective compared with talc Pleurodesis is moderately high (60%) using a threshold of willingness to pay of £20,000/QALY. ![Abstract S79 Figure 1.][1] Abstract S79 Figure 1. References 1. Davies H, Mishra E, Kahan B, et al . Effect of an Indwelling Pleural Catheter vs. Chest Tube and Talc Pleurodesis for Relieving Dyspnea in Patients with Malignant Pleural Effusion. The TIME2 Randomised Controlled Trial. JAMA . 2012;307(22): 2383–2389. [1]: pending:yes
Edward T H Fysh - One of the best experts on this subject based on the ideXlab platform.
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effect of an indwelling pleural catheter vs talc Pleurodesis on hospitalization days in patients with malignant pleural effusion the ample randomized clinical trial
JAMA, 2017Co-Authors: Rajesh Thomas, Edward T H Fysh, Nicola A Smith, Pyng Lee, Benjamin C H Kwan, Elaine Yap, Fiona C Horwood, Francesco PiccoloAbstract:Importance Indwelling pleural catheter and talc Pleurodesis are established treatments for malignant pleural effusions among patients with poor prognosis. Objective To determine whether indwelling pleural catheters are more effective than talc Pleurodesis in reducing total hospitalization days in the remaining lifespan of patients with malignant pleural effusion. Design, Setting, and Participants This open-label, randomized clinical trial included participants recruited from 9 centers in Australia, New Zealand, Singapore, and Hong Kong between July 2012 and October 2014; they were followed up for 12 months (study end date: October 16, 2015). Patients (n = 146) with symptomatic malignant pleural effusion who had not undergone indwelling pleural catheter or Pleurodesis treatment were included. Interventions Participants were randomized (1:1) to indwelling pleural catheter (n = 74) or talc Pleurodesis (n = 72), minimized by malignancy (mesothelioma vs others) and trapped lung (vs not), and stratified by region (Australia vs Asia). Main Outcomes and Measures The primary end point was the total number of days spent in hospital from procedure to death or to 12 months. Secondary outcomes included further pleural interventions, patient-reported breathlessness, quality-of-life measures, and adverse events. Results Among the 146 patients who were randomized (median age, 70.5 years; 56.2% male), 2 withdrew before receiving the randomized intervention and were excluded. The indwelling pleural catheter group spent significantly fewer days in hospital than the Pleurodesis group (median, 10.0 [interquartile range [IQR], 3-17] vs 12.0 [IQR, 7-21] days; P = .03; Hodges-Lehmann estimate of difference, 2.92 days; 95% CI, 0.43-5.84). The reduction was mainly in effusion-related hospitalization days (median, 1.0 [IQR, 1-3] day with the indwelling pleural catheter vs 4.0 (IQR, 3-6) days with Pleurodesis; P Conclusions and Relevance Among patients with malignant pleural effusion, treatment with an indwelling pleural catheter vs talc Pleurodesis resulted in fewer hospitalization days from treatment to death, but the magnitude of the difference is of uncertain clinical importance. These findings may help inform patient choice of management for pleural effusion. Trial Registration anzctr.org.au Identifier:ACTRN12611000567921
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indwelling pleural catheters reduce inpatient days over Pleurodesis for malignant pleural effusion
Chest, 2012Co-Authors: Edward T H Fysh, Grant W Waterer, Peter A Kendall, Peter R Bremner, Sharifa Dina, Elizabeth Geelhoed, Kate MccarneyAbstract:Background Patients with malignant pleural effusion (MPE) have limited prognoses. They require long-lasting symptom relief with minimal hospitalization. Indwelling pleural catheters (IPCs) and talc Pleurodesis are approved treatments for MPE. Establishing the implications of IPC and talc Pleurodesis on subsequent hospital stay will influence patient choice of treatment. Therefore, our objective was to compare patients with MPE treated with IPC vs Pleurodesis in terms of hospital bed days (from procedure to death or end of follow-up) and safety. Methods In this prospective, 12-month, multicenter study, patients with MPE were treated with IPC or talc Pleurodesis, based on patient choice. Key end points were hospital bed days from procedure to death (total and effusion-related). Complications, including infection and protein depletion, were monitored longitudinally. Results One hundred sixty patients with MPE were recruited, and 65 required definitive fluid control; 34 chose IPCs and 31 Pleurodesis. Total hospital bed days (from any causes) were significantly fewer in patients with IPCs (median, 6.5 days; interquartile range [IQR] = 3.75-13.0 vs Pleurodesis, mean, 18.0; IQR, 8.0-26.0; P = .002). Effusion-related hospital bed days were significantly fewer with IPCs (median, 3.0 days; IQR, 1.8-8.3 vs Pleurodesis, median, 10.0 days; IQR, 6.0-18.0; P Conclusions Patients treated with IPCs required significantly fewer days in hospital and fewer additional pleural procedures than those who received Pleurodesis. Safety profiles and symptom control were comparable.