Pleural drainage and pleurodesis; implementation of the Dutch guidelines in four hospitals

¹ Netherlands Cancer Institute, Amsterdam, The Netherlands
² Medical Center of the Free University, Amsterdam, The Netherlands
³ Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
⁴ Leiden University Medical Center, Leiden, The Netherlands
⁵ Dutch Institute for Healthcare Improvement CBO, Utrecht

^* To whom correspondence should be addressed. E-mail: s.burgers{at}nki.nl.

	Abstract

The aim of the present study was to evaluate the implementation of the Dutch 2003 guideline on diagnosis and treatment of malignant pleural effusions, and the potential effect of the implementation on the clinical outcome of pleurodesis.

We prospectively registred all patients n 4 centers with malignant pleural effision who had a pleural drain placed with the intention to perform a pleurodesis. Details of the procedure, data on fluid recurrence and survival were noted.

One hundred patients with a proven malignancy were entered in the registration database. Diagnostic guideline recommendations were followed in 60–70% of the patients. Surprisingly, a pleurodesis was only performed in 75% of the patients, mainly due to the presence of a trapped lung. All pleurodeses were performed by talc, according to the guideline. Follow-up revealed fluid recurrence in 27 patients (36%) after a mean follow-up of 17 days (range 2–285); 14 patients with a successful pleurodesis died with a median survival of 61 days (range 13–174). Systemic treatment after pleurodesis and good apposition of the pleural surfaces during drainage were good prognostic factors.

Despite reasonable to good adherence to the guideline, the number of successful pleurodeses was low. Better predictors for a good outcome of pleurodesis are needed.