EFFICACY OF SHORT-TERM VERSUS LONG-TERM TUBE THORACOSTOMY DRAINAGE BEFORE TETRACYCLINE PLEURODESIS IN THE TREATMENT OF MALIGNANT PLEURAL EFFUSIONS

Background - A study was undertaken to compare the efficacy of short t erm tube thoracostomy drainage with standard tube thoracostomy drainag e before instillation of tetracycline for sclerotherapy of malignant p leural effusions. Methods - The study consisted of a randomised clinic al trial in a sequential sample of 25 patients with malignant pleural effusions documented cytopathologically. Fifteen patients were randoml y assigned to group 1 (standard protocol) and 10 to group 2 (short ter m protocol). Patients in group 1 had tube thoracostomy suction drainag e until radiological evidence of lung re-expansion was obtained and th e amount of fluid drained was < 150 ml/day, before tetracycline (1.5 g ) was instilled. The chest tube was removed when the amount of fluid d rained after instillation was < 150 ml/day. Patients in group 2 also h ad suction drainage, but the tetracycline (1.5 g) was instilled when t he chest radiograph showed the lung to be re-expanded and the effusion drained, which was usually within 24 hours. The chest tube was remove d the next day. Results - The response to tetracycline sclerotherapy i n the two groups was the same (80%) but the duration of chest tube dra inage was significantly shorter for patients in group 2 (median two da ys) than for those in group 1 (median seven days). Conclusions - The d uration of chest tube drainage before sclerotherapy for malignant pleu ral effusions need not be influenced by the amount of fluid drained da ily but by radiographic evidence of fluid evacuation and lung re-expan sion. Shorter duration of drainage will reduce the length of hospital stay without sacrificing the efficacy of pleurodesis.