Does intraprocedure patient positioning affect outcome of chemical pleurodesis for malignant pleural effusion?

Background: Chemical pleurodesis using tetracycline is an acceptable and commonly employed palliation for malignant pleural effusion. Rotation of patient during pleurodesis using the powder from tetracycline capsule is still practised in some centres and is undoubtedly associated with additional stress on the patients. The practice of rotation can only be eliminated after a properly designed study on the outcome of pleurodesis with rotation and non-rotation would fail to show benefit of rotation. Objective: To determine the association between patients positioning and the outcome of tetracycline pleurodesis in patients with malignant pleural effusion. Patients and methods: It is a prospective randomized study involving adults patients with cytologically proven malignant pleural effusion. Patients were randomized into 2 groups (rotation and supine) using alternate sampling technique. Tube thoracostomy was done and tetracycline pleurodesis using 2g of powder from tetracycline capsule via slurry instillation method was carried out. The outcome of the pleurodesis was assessed with a chest radiograph on the 30th day after removal of chest tube. Results: There were 51 patients studied with malignant pleural effusion. These consisted of 12 males (23.5%) and 39 females (76.5%). Twenty-five patients (49.0%) were rotated in the study while 26 patients (51.0%) were on supine position. A total of 30 patients (58.8%) achieved complete response, 16 patients (31.4%) achieved partial response while 5 patients (9.8%) had failed response. The study also showed that in the rotated group, 23 patients (92%) had successful response and 23 patients (88.5%) in the supine group also achieved successful response (P = 0.175); there was no significant difference between the two groups. Conclusion: This study showed that, though the powder from tetracycline capsule is only slightly soluble in water, it gives a good and similar successful outcome in both arms of the study. This implies that positioning of patient during pleurodesis plays no significant role in the outcome of tetracycline pleurodesis using the powder from tetracycline capsule.