Patient evaluation for rapid pleurodesis of malignant pleural effusions

An estimated 150,000 people experience malignant pleural effusions (MPEs) yearly in the United States (1). MPEs cause discomfort secondary to dyspnea, chest pain, and cough (2,3). Treatment options include recurrent thoracenteses, chemical pleurodesis, and placement of an indwelling tunneled pleural catheter (TPC). Each modality has both advantages and disadvantages for different patient groups. Repeat thoracenteses are generally not recommended as nearly all MPEs will recur within four weeks even on treatment for their malignancy (4). A disadvantage of pleurodesis is that it often necessitates a 5- to 7-day hospitalization (5,6). While placement of TPCs alone have been found to cause spontaneous pleurodesis after a median of 56 days (7,8), there is an inherent infectious risk with TPCs as well as the need for assistance with home drainage (9-11)