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

Abstract

BACKGROUND:

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.

• Authors: Fredric A Hoffer, Michael L Hancock, Pamela S Hinds, Nikita Oigbokie, Shesh N Rai, Bhaskar Rao
• Journal: Pediatric radiology (Pediatr Radiol) Vol. 37 Issue 3 Pg. 269-73 (Mar 2007) ISSN: 0301-0449 [Print] Germany
• PMID: 17203294 (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