Pleurodese nos derrames pleurais malignos: um inquérito entre médicos em países da América do Sul e Central

Abstract

Objective: Pleurodesis is an effective alternative for the control of malignant pleural effusions. However, there is as yet no consensus regarding the indications for the procedure and the techniques employed therein. The objective of this study was to evaluate how pleurodesis is performed in South and Central America. Methods: Professionals who perform pleurodesis completed a questionnaire regarding the indications for the procedure, the techniques used therein, and the outcomes obtained. Results: Our sample comprised 147 respondents in Brazil, 49 in other South American countries, and 36 in Central America. More than 50% of the respondents reported performing pleurodesis only if pleural malignancy had been confirmed. However, scores on dyspnea and performance status scales were rarely used as indications for the procedure. Nearly 75% of the respondents in Brazil and in Central America preferred to perform pleurodesis only for recurrent effusions and stated that lung expansion should be 90-100%. Talc slurry, instilled via medium-sized chest tubes, was the agent most often employed. Thoracoscopy was performed in less than 25% of cases. Fever and chest pain were the most common side effects, and empyema occurred in ≤ 14% of cases. The mean survival time after the procedure was most often reported to be 6-12 months. Conclusions: There was considerable variation among the countries evaluated in terms of the indications for pleurodesis, techniques used, and outcomes. Talc slurry is the agent most commonly used, and thoracoscopy is the technique of choice in Brazil. Pleurodesis is an effective procedure that has few side effects, as evidenced by the low complication rates and high survival times.Keywords: Pleural effusion, malignant; Pleura; Pleurodesis. ResumoObjetivo: A pleurodese é uma alternativa eficaz no controle dos derrames pleurais malignos, mas existem controvérsias a respeito de sua indicação e técnica. O objetivo deste estudo foi avaliar como é realizada a pleurodese em países da América do Sul e Central. Métodos: Profissionais que realizam pleurodese responderam um questionário sobre critérios de indicação para pleurodese, técnicas utilizadas e desfechos. Resultados: Nossa amostra envolveu 147 profissionais no Brasil, 49 em outros países da América do Sul e 36 em países da América Central. Mais de 50% dos participantes realizavam pleurodese somente se confirmada a malignidade no derrame pleural. Entretanto, escalas de dispneia e de status de performance eram raramente utilizadas para indicar o procedimento. Aproximadamente 75% dos participantes no Brasil e na América Central preferiam realizar a pleurodese somente no caso de recidiva do derrame, e a expansão pulmonar deveria variar de 90% a 100%. O talco slurry foi o agente mais utilizado, instilado via drenos de calibre intermediário. A toracoscopia foi realizada em menos de 25% dos casos. Febre e dor torácica foram os efeitos adversos mais comuns, e empiema ocorreu em ≤ 14% dos casos. A média de sobrevida após o procedimento variou entre 6 e 12...

Practice patterns and trends in surgical treatment for chronic lung infections: a survey from the Brazilian Society of Thoracic Surgery

“…This study has potential limitations that need to be considered when interpreting the results. Although our response rate is consistent with other electronic healthcare professionals’ surveys ( 21 , 22 ), it can be considered low. Both the length of the questionnaire and the fact that it was sent electronically likely contributed to our low response rate.…”

A survey of recently published cardiovascular, hematological and pneumological original articles in the Brazilian scientific press

“…Rodrigues et al96 analyzed the association between paracoccidioidomycosis (Pcm) and cancer in a series of 25 cases and to review the literature on this topic and claim that a diagnosis of Pcm appears to increase the risk of lung cancer. Marchi et al97 evaluated how pleurodesis is performed in South and Central America and found considerable variation among the countries evaluated in terms of the indications for pleurodesis, techniques used, and outcomes. Talc slurry is the agent most commonly used, and thoracoscopy is the technique of choice in Brazil.…”

Acute pneumonitis consequent on pleurodesis with Viscum album extract: severe chest images but benign clinical course

“…Chemical pleurodesis is widely recommended in the treatment of pulmonary air leak of different etiologies as well as malignant pleural effusions and chylothorax [ 7 , 9 – 11 ]. Instillation of a sclerosing agent into the pleural space elicits an inflammatory reaction in the pleura that allows for the obliteration of the pleural space and resolution of an air leak or pleural effusion.…”

“…Instillation of a sclerosing agent into the pleural space elicits an inflammatory reaction in the pleura that allows for the obliteration of the pleural space and resolution of an air leak or pleural effusion. Numerous sclerotic agents, including erythromycin, tetracycline, hydrophilic fumed silica, autologous blood and talc slurry [ 9 , 12 – 14 ] have been used to produce pleural symphysis, and several studies have investigated the efficacy and complications of them. Reported usual minor complications of pleurodesis are high fever, severe pain, tachycardia, and dyspnea.…”