Conventional versus pigtail

chest tube—are they similar for

treatment
of malignant pleural effusions?
MARIA AURORA MENDES & NUNO CHINA PEREIRA & CARLA RIBEIRO &
MANUELA VANZELLER & TERESA SHIANG & RITA GAIO &SÉRGIO CAMPAINHA
INTRODUCTION

 Malignant pleural effusion (MPE) is a common clinical problem associated

with debilitating breathlessness in patients with poor performance status
and short life expectancy
 Chest tube drainage followed by chemical pleurodesis is an available
approach. Type and size remains controversial
 this study aimed to compare the efficacy of conventional versus pigtail
chest tube in the drainage and pleurodesis of MPEs.
METHODS

 retrospective study of patients submitted to chest tube drainage and talc

slurry pleurodesis due to MPE in our pulmonology ward from January of
2012 to December of 2016.
 MPEs were defined as confirmed histocytological pleural malignancy or
otherwise unexplained pleural effusion in the context of histocytologically
proven malignancy elsewhere
 Patients were divided to 2 groups:
 Group 1: conventional
 Group 2: pigtail
RESULTS
DISCUSSION

 In this study, about a quarter of patients (24.6%) were treated with pigtail
chest tube. The extensive experience in conventional chest tube
placement, the long-held notion of blockage of small-bore chest tubes,
and the higher purchase price of pigtail chest tubes could explain this
finding.
 In our study, the number of recurrences was low comparing to previous
series
 Parulekar et al. recorded actuarial probabilities of recurrence at 6 weeks
of 45 and 41% for the small-bore and the larger-bore chest tubes,
respectively
 Burgers et al observed recurrence in 36% of enrolled patients at 17 days
following pleurodesis
 Recurrence at 4 weeks was similar between conventional and pigtail,
previous studies have also suggested that small-bore chest tubes have
comparable success rates to larger-bore chest tubes
 British Thoracic Society guidelines recommends small-bore chest tubes as
the initial choice for effusion drainage and pleurodesis ini MPE
 Duration of hospital stay and timelines associated with the procedures
were not significantly different between 2 groups
 Indwelling pleural catheters (IPC) are increasingly used as an alternative to
pleurodesis
 Although not extensive, relevant literature and clinical experience have
suggested that IPC are as effective as pleurodesis in relieving symptoms,
reducing hospital stay, even avoiding hospitalization, and improve quality
of life
CONCLUSION

 Pigtail chest tube can be alternative on palliation, with apparently no

compromise in pleurodesis performance