A COMPARISON OF ROTATION AND NONROTATION IN TETRACYCLINE PLEURODESIS

Previously, we have shown rapid and complete dispersion of tetracyclin e hydrochloride in the pleural space following chest tube instillation . To assess the clinical relevance of this observation, we randomized patients with symptomatic pleural effusions to rotation (R) (n = 19) a nd nonrotation (NR) (n = 21) groups following administration of tetrac ycline hydrochloride, 20 mg/kg (n = 30); 300 mg of minocycline hydroch loride (n = 6); and 500 mg of doxycycline hydrochloride (n = 4) throug h a chest tube. Patients in the R group were maneuvered through six po sitions for the 2 h that the chest tube remained clamped. The NR patie nts remained supine for 2 h. Rotation and nonrotation groups were simi lar in demographics, source of pleural effusion, symptoms, and serum a nd pleural fluid analyses (all p=NS). A chest radiograph was scored ba sed on pleural fluid recurrence throughout survival or up to 12 months . Survival, duration of chest tube instillation, and success of pleuro desis assessed by radiographic pleural fluid reaccumulation (73.7 vs 6 1.9 percent; R vs NR) were similar (p = NS). Rotational maneuvers appe ar to offer no benefit to the success of pleural symphysis after intra pleural instillation of tetracycline class agents.