A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was whether chemical
pleurodesis is superior to
catheter drainage or pleuroperitoneal shunts (PPS) in the management of patients with
pleural effusions. Overall 161 papers were found using the reported search, of which 14 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results are tabulated. We conclude that chemical
pleurodesis is superior to chronic
catheter drainage and PPS in terms survival length and mortality rates but in patients with trapped lung syndrome chronic intrapleural
catheter placement is indicated. Six studies reported patient outcomes
after treatment with chemical
pleurodesis. They report high success rates (89.4%) and low mortality rates (2%) without any need to convert to open
thoracotomy. Mean
hospital stay of 2.33 days, complication rates of 16.5% and mean survival length of 23.8 ± 16.3 months were observed. Five studies managed
malignant pleural effusions (MPEs) using chronic
indwelling catheters. They reported mean survival length of 126 days. Symptomatic relief was achieved in 94.2% of patients. There was a significant reduction in the Medical Research Council dyspnoea score (3.0-1.9, P < 0.001) and despite complication rates of 22%, comparable mortality rates (7.5%) were observed. Even in patients with trapped lung syndrome, mean survival length was 125 days with symptomatic improvement being achieved in 90.9% of patients. Three studies treated MPEs using PPSs. Mean
hospital stay was 6.2 days (range 2-26) with a mean survival length of 11 months.
Pleurodesis success rates varied from 57.1% to 95% with a complication rate of 14.8%. PPSs were shown to produce lower success rates (57.1% vs. 92.3%), shorter survival lengths (4.3 ± 1.9 vs. 6.7 ± 2.1 months) and higher complication rates (14.3% vs. 2.8%) than
talc pleurodesis. Overall, chemical
pleurodesis is the optimal treatment option for MPE with use of chronic intrapleural
catheters reserved in cases where
talc pleurodesis is not possible.