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Elastance of the Pleural Space: A Predictor for the Outcome of Pleurodesis in Patients with Malignant Pleural Effusion

Ray-Shee Lan, MD; Sing Kai Lo, PhD; Ming-Lung Chuang, MD; Cheng-Ta Yang, MD; Thomas Chang-Yao Tsao, MD; and Cheng-Huei Lee, MD
[+] Article and Author Information

From Chang Gung Medical College, Taipei, Taiwan; and Deakin University, Burwood, Australia. Acknowledgment: The authors thank Professor Delon Wu for critical review of the manuscript. Grant Support: In part by Chang Gung Memorial Hospital grants CMRP 417 and CMRP 512. Requests for Reprints: Ray-Shee Lan, MD, Department of Chest Medicine, Chang Gung Memorial Hospital, 199 Tung Hwa North Road, Taipei 10591, Taiwan. Current Author Addresses: Drs. Lan, Chuang, Yang, Tsao, and Lee: Department of Chest Medicine, Chang Gung Memorial Hospital, 199 Tung Hwa North Road, Taipei 10591, Taiwan. Dr. Lo: FHBS, Deakin University, 221 Burwood Highway, Burwood VIC 3125, Australia.


Copyright ©2004 by the American College of Physicians


Ann Intern Med. 1997;126(10):768-774. doi:10.7326/0003-4819-126-10-199705150-00003
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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.

Figures

Grahic Jump Location
Figure 1.
Device used to measure the elastance of the pleural space.
Grahic Jump Location
Grahic Jump Location
Figure 2.
Categories of reexpansion of the affected lung and approximation of the pleurae.

Arrowheads mark the trapped lung.

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Grahic Jump Location
Figure 3.
Relation of pleural elastance, effusion pH, effusion glucose level, trapped lung, and outcome of pleurodesis.

x = patients who were lost to follow-up; open circle = patients with successful pleurodesis; ● = patients with unsuccessful pleurodesis; group 1 = patients with trapped lung lost to follow-up at 1 month; group 2 = patients without trapped lung lost to follow-up at 1 month; group 3 = patients without trapped lung with successful pleurodesis at 1 month; group 4 = patients with trapped lung with unsuccessful pleurodesis at 1 month; group 5 = patients without trapped lung with unsuccessful pleurodesis at 1 month.

Grahic Jump Location

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