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Pleurodesis for effusions in pediatric oncology patients at end of life.

AbstractBACKGROUND: Pleurodesis for end-of-life care has been used in adults for decades, but little is known about the usefulness of this technique in improving the quality of care for pediatric patients. OBJECTIVE: To assess whether intractable pleural effusions in pediatric oncology patients at end of life could be sufficiently relieved by pleurodesis. MATERIAL AND METHODS: Eleven pleurodeses were performed with doxycycline in seven pediatric cancer patients (age 3-21 years) with intractable pleural effusions at the end of life. Five patients had unilateral pleurodeses and two had a unilateral followed by bilateral pleurodeses. RESULTS: Respiratory rates decreased in all seven patients (P = 0.016) and aeration improved significantly after chest tube placement (P = 0.033). The chest tubes were placed a median of 1 day before pleurodesis. Eight of nine chest tubes (89%) were removed before discharge at a median of 3 days after pleurodesis. Pain secondary to the pleurodesis lasted 1 day or less. Improvement in the respiratory rate remained after pleurodesis and chest tube removal (P = 0.031). Five of seven patients (70%) were able to leave the hospital to return home. The five patients discharged lived 10 to 49 days (median 19 days) after discharge. CONCLUSION: Pediatric oncology patients with intractable effusions at end of life can have respiratory benefit from pleurodeses and, as a result, are more likely to return home for terminal care.
AuthorsFredric A Hoffer, Michael L Hancock, Pamela S Hinds, Nikita Oigbokie, Shesh N Rai, Bhaskar Rao (Affiliation: Department of Radiological Sciences, St. Jude Children's Research Hospital, Memphis, TN, USA. fred.hoffer at seattlechildrens.org)
JournalPediatric radiology (Pediatr Radiol) Vol. 37 Issue 3 Pg. 269-73 (Mar 2007) ISSN: 0301-0449 Germany
PMID17203294 (Publication Type: Comparative Study, Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)
Chemical References
  • Doxycycline
Topics
  • Adolescent
  • Adult
  • Chest Tubes
  • Child
  • Child, Preschool
  • Device Removal
  • Doxycycline (therapeutic use)
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Neoplasms (therapy)
  • Oxygen Consumption (physiology)
  • Palliative Care
  • Patient Discharge
  • Pleural Effusion, Malignant (drug therapy)
  • Pleurodesis
  • Respiration
  • Retrospective Studies
  • Survival Rate
  • Terminal Care