medwireNews: Using thoracic ultrasonography to guide pleurodesis leads to shorter hospital stays, with similar success rates, compared with standard care in people with malignant pleural effusion (MPE), SIMPLE study findings indicate.
“Based on these data, thoracic ultrasonography-guidance should now be considered to replace the current standard of care for patients having pleurodesis for MPE,” write Maged Hassan (Churchill Hospital, Oxford, UK) and co-authors in The Lancet Respiratory Medicine.
They found that the median length of hospital stay was 2 days among 149 adults randomly assigned to receive thoracic ultrasonography-guided talc pleurodesis. This was significantly shorter than the median stay of 3 days needed by the 148 participants who received standard care.
Furthermore, the results were similar regardless of the method of talc administration (talc slurry or poudrage) or chest tube size.
The researchers explain that ultrasonography-guided care involved daily bedside examination for lung sliding in nine regions to create an adherence score. If adherence is present, 1 point is given; if it is questionable, 2 points are given; and if there is no evidence of adherence, 3 points are given. This results in a minimum score of 9 points, which indicates preserved sliding, and a maximum of 27 points, indicating complete absence of sliding. Chest tubes were removed if the score was more than 20 points or if 3 points were awarded for each of the three zones at the midaxillary line.
In the standard care group, tube removal was based on daily output volume according to the British Thoracic Society Guidelines (<250 mL/24 h).
A per-protocol analysis revealed that pleurodesis failure rates at 3 months were similar between the two arms, at 29.7% among 91 patients in the intervention group versus 31.2% among 109 patients in the standard care group. The mean risk difference of 1.5% did not cross the prespecified noninferiority margin of 15.0%.
Chest tube removal in the per-protocol population took place significantly earlier among the patients who received ultrasonography-guided care relative to those who did not, at a mean of 2.3 versus 3.1 days, and Hassan et al note that the findings were similar for the intention-to-treat population.
The investigators observed no significant between-group differences in all-cause mortality or patient-reported symptom scores, and they also report that costs were similar for the two methods.
Hassan et al conclude: “This highly novel study, as the first randomised trial in which treatment is directed by bedside ultrasonography, challenges current treatment practices for patients with MPE who have talc pleurodesis.”
They add: “Although experience and training are required to assess lung sliding, the study intervention is a simple procedure that relies on technology widely available in hospitals across the world.”
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