EFFICACY OF RAPID PLEURODESIS IN MALIGNANT PLEURAL EFFUSIONS: A META‐ANALYSIS

Abstract

Background: The standard procedure for pleurodesis involves instillation of a sclerosing agent thru a pleural drain only when daily drainage is less than a specific amount of fluid (between 100-300 mL/day). Despite this consensus, there has been no well-documented evidence for this practice and often necessitates prolonged admission and increases hospital costs. A rapid protocol wherein the agent is immediately given after full drainage and demonstration of lung expansion has been shown to be as effective in several small trials. Objective: s: To assess the efficacy of using a rapid protocol compare to the standard protocol in achieving pleurodesis success. Methods: The two authors (RA and BA) independently searched the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed/ MEDLINE, EMBASE, clinicaltrials.gov, Herdin and SCOPUS for studies comparing the efficacy of rapid pleurodesis to the standard protocol, published until July 2019. Validity of studies was assessed through the Cochrane risk assessment tool. Efficacy of pleurodesis protocol was estimated by calculating the Mantel-Haenszel-weighted risk ratio (RR) using a random-effects model available from RevMan 5.3. Results: A total of five studies comprising 392 patients (Rapid protocol group = 196, Standard group = 196) were included in the final analysis. There was no significant difference in the rates of pleurodesis success between the standard protocol group (172/196) and the rapid protocol group (168/196) (RR 0.97, 95% confidence interval [CI], 0.90-1.05; P=0.49). Length of hospital stay was significantly shorter for patients in the rapid protocol group (MD -4.18 hospital days, 95% CI -6.74, -1.61; P=0.0002). There was no difference in mortality rate between the two groups (RR 0.95, 95% CI 0.48, 1.88; P=0.89) Conclusion: Pleurodesis using a rapid protocol is not inferior to the standard protocol and may result in a shorter hospital stay. However, due to the small size of available studies, larger randomized controlled trials are necessary to verify these findings.