AMPLE time admitted.

Malignant pleural effusion can be very distressing at the end of life, and that distress can cause patients to get hospitalized. Talc pleurodesis and indwelling catheter are two common approaches to managing this problem. Both require procedures, and both have downsides. Pleurodesis can often fail and require additional fluid management, while catheters require ongoing maintenance. The AMPLE trial published last week in JAMA compared these two techniques to see which resulted in the fewest days in the hospital. Sadly, all these patients spent a sizable chunk of time admitted...as in a median chunk of 10 days! Second, indwelling catheters technically resulted in shorter admissions with a mean reduction of 3.6 days. Finally, pleurodesis required hella more pleural interventions (22.5%) than the catheters (4.1%). Bottomline: patients with malignant pleural effusions have it bad, but pleural catheters may make it a little less bad.