Elastance of the pleural space: A predictor for the outcome of pleurodesis in patients with malignant pleural effusion

Ray-Shee LAN, Sing Kai LO, Ming-Lung CHUANG, Cheng-Ta YANG, Thomas Chang-Yao TSAO, Cheng-Huei LEE

Research output: Contribution to journalArticle

90 Citations (Scopus)

Abstract

Background: In patients who have malignant pleural effusion, it is difficult to diagnose trapped lung before thoracoscopy, thoracostomy, and drainage of the effusion. Predicting the outcome of pleurodesis in patients who have malignant pleural effusion without trapped lung is also difficult. 
Objective: To investigate the factors that may be useful in diagnosing trapped lung and predicting the outcome of pleurodesis. 
Design: Prospective cohort study. 
Setting: University medical center. 
Patients: 65 patients with symptomatic malignant pleural effusion. 
Intervention: A chest tube was inserted for drainage of the effusion, and pleurodesis was done using bleomycin as the sclerosant. 
Measurements: The pH and glucose levels of the effusion and the elastance of the pleural space (defined as the decline in pleural fluid pressure in cm H₂O after removal of 500 mL of effusion) were measured. The outcome of pleurodesis was evaluated 1 month after the chest tube was removed. 
Results: Patients with an elastance of 19 cm H₂O or more had a higher incidence of trapped lung (11 of 14 patients) than did those with an elastance less than 19 cm H₂O (3 of 51 patients) (P < 0.001). None of the 14 patients with an elastance of 19 cm H₂O or more and none of the 14 patients with a trapped lung had successful pleurodesis. Forty-two of 43 patients with an elastance less than 19 cm H₂O who did not have a trapped lung had successful pleurodesis. Elastance seemed to be the best predictor for trapped lung and outcome of pleurodesis, although outcome was also correlated with pH and glucose levels of the effusion. Low-dose bleomycin (30 mg) is as effective as the usual dose of bleomycin (60 mg) for pleurodesis. 
Conclusion: In patients with symptomatic malignant pleural effusion, measurement of the elastance of the pleural space is a simple and effective method for the diagnosis of trapped lung and prediction of the outcome of chemical pleurodesis with bleomycin. Copyright © 1997 American College of Physicians.
Original languageEnglish
Pages (from-to)768-774
JournalAnnals of Internal Medicine
Volume126
Issue number10
DOIs
Publication statusPublished - 1997

Fingerprint

Pleurodesis
Malignant Pleural Effusion
Lung
Bleomycin
Chest Tubes
Drainage
Thoracostomy
Sclerosing Solutions
Glucose
Thoracoscopy
Pleural Effusion
Cohort Studies

Citation

Lan, R.-S., Lo, S. K., Chuang, M.-L., Yang, C.-T., Tsao, T. C.-Y., & Lee, C.-H. (1997). Elastance of the pleural space: A predictor for the outcome of pleurodesis in patients with malignant pleural effusion. Annals of Internal Medicine, 126(10), 768-774. doi: 10.7326/0003-4819-126-10-199705150-00003