Inderpal Thethi1, Shokufeh Ramirez2, Wei Shen3,4, Dingding Zhang3,5, Maha Mohamad1, Upendra Kaphle1, Fayez Kheir1. 1. Division of Pulmonary Diseases, Critical Care and Environmental Medicine, Tulane University Health Sciences Center, New Orleans, LA, USA. 2. Department of Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA. 3. Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA. 4. Department of Epidemiology and Biostatistics, Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Cancer Personalized Medicine, School of Public Health, Nanjing Medical University, Nanjing 211166, China. 5. Department of Evidence Based Medicine, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center of Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China.
Abstract
BACKGROUND: Malignant pleural effusion (MPE) develops in approximately 50% of all patients with metastatic cancer. The efficacy of small- vs. large-bore chest tube for pleurodesis in patients with MPE is still not clear. METHODS: We performed a meta-analysis to evaluate the efficacy and safety of chest tube size in the management of MPE. A systematic search of Medline (Ovid) and Embase (from 1980 to March 2016) was performed. Randomized clinical trials (RCTs) evaluating the effect of small (≤14 French) vs. large (>14 French) chest tube size on successful pleurodesis for patients with MPE. Of 708 potentially relevant publications, four matched the selection criteria and were included in the meta-analysis. RESULTS: Overall relative risk (RR) with 95% confidence intervals (CI) was pooled using a random-effects model. Heterogeneity was assessed using Q statistic (significant at P<0.1). In the 231 patients, the success proportion of pleurodesis as well as complication proportion were comparable between large and small chest tube groups with a pooled RR of 0.90 (95% CI, 0.77-1.05; P=0.19; I2 =17.4%) and 0.95 (95% CI, 0.42-2.15; P=0.90; I2 =0.9%) respectively. Successful pleurodesis and complication proportion for small vs. large chest tubes were 73.8% vs. 82.0% and 13.0% vs. 10.5%, respectively. CONCLUSIONS: This meta-analysis suggests that small and large chest tubes are both effective treatment for MPE with similar successful pleurodesis and complication proportion. Further RCTs are needed to more clearly determine which size tube is superior.
BACKGROUND: Malignant pleural effusion (MPE) develops in approximately 50% of all patients with metastatic cancer. The efficacy of small- vs. large-bore chest tube for pleurodesis in patients with MPE is still not clear. METHODS: We performed a meta-analysis to evaluate the efficacy and safety of chest tube size in the management of MPE. A systematic search of Medline (Ovid) and Embase (from 1980 to March 2016) was performed. Randomized clinical trials (RCTs) evaluating the effect of small (≤14 French) vs. large (>14 French) chest tube size on successful pleurodesis for patients with MPE. Of 708 potentially relevant publications, four matched the selection criteria and were included in the meta-analysis. RESULTS: Overall relative risk (RR) with 95% confidence intervals (CI) was pooled using a random-effects model. Heterogeneity was assessed using Q statistic (significant at P<0.1). In the 231 patients, the success proportion of pleurodesis as well as complication proportion were comparable between large and small chest tube groups with a pooled RR of 0.90 (95% CI, 0.77-1.05; P=0.19; I2 =17.4%) and 0.95 (95% CI, 0.42-2.15; P=0.90; I2 =0.9%) respectively. Successful pleurodesis and complication proportion for small vs. large chest tubes were 73.8% vs. 82.0% and 13.0% vs. 10.5%, respectively. CONCLUSIONS: This meta-analysis suggests that small and large chest tubes are both effective treatment for MPE with similar successful pleurodesis and complication proportion. Further RCTs are needed to more clearly determine which size tube is superior.
Authors: Najib M Rahman; Nicholas A Maskell; Christopher W H Davies; Emma L Hedley; Andrew J Nunn; Fergus V Gleeson; Robert J O Davies Journal: Chest Date: 2009-10-09 Impact factor: 9.410
Authors: Najib M Rahman; Justin Pepperell; Sunita Rehal; Tarek Saba; Augustine Tang; Nabeel Ali; Alex West; Gihan Hettiarachchi; Dipak Mukherjee; Johnson Samuel; Andrew Bentley; Lee Dowson; Jonathan Miles; C Frank Ryan; Ken Y Yoneda; Anoop Chauhan; John P Corcoran; Ioannis Psallidas; John M Wrightson; Rob Hallifax; Helen E Davies; Y C Gary Lee; Melissa Dobson; Emma L Hedley; Douglas Seaton; Nicky Russell; Margaret Chapman; Bethan M McFadyen; Rachel A Shaw; Robert J O Davies; Nick A Maskell; Andrew J Nunn; Robert F Miller Journal: JAMA Date: 2015 Dec 22-29 Impact factor: 56.272