Role of thoracic ultrasonography in pleurodesis pathways for malignant pleural effusions (SIMPLE): an open-label, randomised controlled trial

Psallidas I et al.

Lancet Respir Med Volume 10, Issue 2, February 2022, Pages 139-148

What is the key question?

  • Does the use of thoracic ultrasonography shorten the length of hospital stay in patients with malignant pleural effusions (MPE) undergoing talc pleurodesis?

What is the bottom line?

  • This SIMPLE trial is an open-label, multicenter, randomized controlled trial that randomized 1:1 adult patients with MPE to thoracic ultrasonography-guided care (n=159) or standard care (n=154).
  • In the intervention group, daily thoracic ultrasonography examination for lung sliding in nine regions was done to derive an adherence score: present (1 point), questionable (2 points), or absent (3 points), with a lowest possible score of 9 (preserved sliding) and a highest possible score of 27 (complete absence of sliding). The chest tube was removed if the score was more than 20. In the standard care group, tube removal was based on daily output volume per BTS guidelines.
  • The median length of hospital stay was significantly shorter in the intervention group (2 days) than in the standard care group (3 days) with a p < 0.0001. Thoracic ultrasonography-guided care was non-inferior to standard care in terms of pleurodesis failure at 3 months. Mean time to chest tube removal in the intervention group was 2·4 days versus 3·1 days in the standard care group (p=0.0057). There were no significant between-group differences in all-cause mortality, symptom scores, or quality-of life scores, except on the EQ-5D visual analogue scale, which was significantly lower in the standard care group at 3 months. Although costs were similar between the groups, thoracic ultrasonography-guided care was cost-effective compared with standard care.

Why read on?

  • This study supports consideration of standard use of thoracic ultrasonography in patients undergoing pleurodesis for MPE.