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Randomized Trial of Pleural Fluid Drainage Frequency in Patients with Malignant Pleural Effusions. The ASAP Trial.

Publication ,  Journal Article
Wahidi, MM; Reddy, C; Yarmus, L; Feller-Kopman, D; Musani, A; Shepherd, RW; Lee, H; Bechara, R; Lamb, C; Shofer, S; Mahmood, K; Michaud, G ...
Published in: Am J Respir Crit Care Med
April 15, 2017

RATIONALE: Patients with malignant pleural effusions have significant dyspnea and shortened life expectancy. Indwelling pleural catheters allow patients to drain pleural fluid at home and can lead to autopleurodesis. The optimal drainage frequency to achieve autopleurodesis and freedom from catheter has not been determined. OBJECTIVES: To determine whether an aggressive daily drainage strategy is superior to the current standard every other day drainage of pleural fluid in achieving autopleurodesis. METHODS: Patients were randomized to either an aggressive drainage (daily drainage; n = 73) or standard drainage (every other day drainage; n = 76) of pleural fluid via a tunneled pleural catheter. MEASUREMENTS AND MAIN RESULTS: The primary outcome was the incidence of autopleurodesis following the placement of the indwelling pleural catheters. The rate of autopleurodesis, defined as complete or partial response based on symptomatic and radiographic changes, was greater in the aggressive drainage arm than the standard drainage arm (47% vs. 24%, respectively; P = 0.003). Median time to autopleurodesis was shorter in the aggressive arm (54 d; 95% confidence interval, 34-83) as compared with the standard arm (90 d; 95% confidence interval, 70 to nonestimable). Rate of adverse events, quality of life, and patient satisfaction were not significantly different between the two arms. CONCLUSIONS: Among patients with malignant pleural effusion, daily drainage of pleural fluid via an indwelling pleural catheter led to a higher rate of autopleurodesis and faster time to liberty from catheter. Clinical trial registered with www.clinicaltrials.gov (NCT 00978939).

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Published In

Am J Respir Crit Care Med

DOI

EISSN

1535-4970

Publication Date

April 15, 2017

Volume

195

Issue

8

Start / End Page

1050 / 1057

Location

United States

Related Subject Headings

  • Time Factors
  • Surveys and Questionnaires
  • Single-Blind Method
  • Respiratory System
  • Recurrence
  • Quality of Life
  • Pleural Effusion, Malignant
  • Patient Satisfaction
  • Male
  • Humans
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Wahidi, M. M., Reddy, C., Yarmus, L., Feller-Kopman, D., Musani, A., Shepherd, R. W., … Light, R. W. (2017). Randomized Trial of Pleural Fluid Drainage Frequency in Patients with Malignant Pleural Effusions. The ASAP Trial. Am J Respir Crit Care Med, 195(8), 1050–1057. https://doi.org/10.1164/rccm.201607-1404OC
Wahidi, Momen M., Chakravarthy Reddy, Lonny Yarmus, David Feller-Kopman, Ali Musani, R Wesley Shepherd, Hans Lee, et al. “Randomized Trial of Pleural Fluid Drainage Frequency in Patients with Malignant Pleural Effusions. The ASAP Trial.Am J Respir Crit Care Med 195, no. 8 (April 15, 2017): 1050–57. https://doi.org/10.1164/rccm.201607-1404OC.
Wahidi MM, Reddy C, Yarmus L, Feller-Kopman D, Musani A, Shepherd RW, et al. Randomized Trial of Pleural Fluid Drainage Frequency in Patients with Malignant Pleural Effusions. The ASAP Trial. Am J Respir Crit Care Med. 2017 Apr 15;195(8):1050–7.
Wahidi, Momen M., et al. “Randomized Trial of Pleural Fluid Drainage Frequency in Patients with Malignant Pleural Effusions. The ASAP Trial.Am J Respir Crit Care Med, vol. 195, no. 8, Apr. 2017, pp. 1050–57. Pubmed, doi:10.1164/rccm.201607-1404OC.
Wahidi MM, Reddy C, Yarmus L, Feller-Kopman D, Musani A, Shepherd RW, Lee H, Bechara R, Lamb C, Shofer S, Mahmood K, Michaud G, Puchalski J, Rafeq S, Cattaneo SM, Mullon J, Leh S, Mayse M, Thomas SM, Peterson B, Light RW. Randomized Trial of Pleural Fluid Drainage Frequency in Patients with Malignant Pleural Effusions. The ASAP Trial. Am J Respir Crit Care Med. 2017 Apr 15;195(8):1050–1057.

Published In

Am J Respir Crit Care Med

DOI

EISSN

1535-4970

Publication Date

April 15, 2017

Volume

195

Issue

8

Start / End Page

1050 / 1057

Location

United States

Related Subject Headings

  • Time Factors
  • Surveys and Questionnaires
  • Single-Blind Method
  • Respiratory System
  • Recurrence
  • Quality of Life
  • Pleural Effusion, Malignant
  • Patient Satisfaction
  • Male
  • Humans