Chest
Volume 104, Issue 6, December 1993, Pages 1763-1766
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clinical investigations: Leura: Clinical Trial: Comparative Study: Journal Article: Randomized Controlled Trial
A Comparison of Rotation and Nonrotation in Tetracycline Pleurodesis

https://doi.org/10.1378/chest.104.6.1763Get rights and content

Previously, we have shown rapid and complete dispersion of tetracycline hydrochloride in the pleural space following chest tube instillation. To assess the clinical relevance of this observation, we randomized patients with symptomatic pleural effusions to rotation (R) (n = 19) and nonrotation (NR) (n = 21) groups following administration of tetracycline hydrochloride, 20 mg/kg (n = 30); 300 mg of minocycline hydrochloride (n = 6); and 500 mg of doxycycline hydrochloride (n = 4) through a chest tube. Patients in the R group were maneuvered through six positions for the 2 h that the chest tube remained clamped. The NR patients remained supine for 2 h. Rotation and nonrotation groups were similar in demographics, source of pleural effusion, symptoms, and serum and pleural fluid analyses (all p = NS). A chest radiograph was scored based on pleural fluid recurrence throughout survival or up to 12 months. Survival, duration of chest tube instillation, and success of pleurodesis assessed by radiographic pleural fluid reaccumulation (73.7 vs 61.9 percent; R vs NR) were similar (p = NS). Rotational maneuvers appear to offer no benefit to the success of pleural symphysis after intrapleural instillation of tetracycline class agents.

Section snippets

Clinical Data

Between 1987 and 1992, patients with chronic, symptomatic pleural effusions receiving intrapleural instillation of tetracycline class drugs for pleurodesis were randomized, after informed consent, to R or NR groups based on the last digit of their hospital number. Although previous drainage procedures were not considered exclusionary, no prior intrapleural instillation therapy was allowed. No patient with malignant effusion received chemotherapy or radiation therapy within 2 weeks of study.

RESULTS

Fifty-two patients were enrolled in the study. One patient in the R group and two in the NR set were unavailable for follow-up prior to the 1-month evaluation and were eliminated from the study. Two patients in each group died prior to the 1-month assessment, three patients (1 R, 2 NR) had improper technique during instillation, and two (1 R, 1 NR) had a concomitant loculated pneumothorax complicating their pleural disease. Of the 40 remaining patients, 19 were rotated and 21 remained supine.

DISCUSSION

Although rapid dispersal of liquids injected into the pleural space has been documented,13, 14 the efficacy of tetracycline hydrochloride-induced pleural symphysis without rotation previously has not been shown. Several factors, such as mesothelial cell death and sloughing,15, 16, 17, 18 inhibition of fibrinolysis,19 and fibroblast chemotaxis and proliferation15, 20, 21 appear to be dependent on the concentration of the pleurodesis agent for its effect. However, the extent of pleural surface

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