A Propensity-Matched Comparison of Pleurodesis or Tunneled Pleural Catheter for Heart Failure Patients With Recurrent Pleural Effusion

Freeman, Richard K.; Ascioti, Anthony J.; Dake, Megan; Mahidhara, Raja S.

doi:10.1016/j.athoracsur.2014.02.027

Cited by 33 publications

(22 citation statements)

References 11 publications

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“…Patient satisfaction is high, not least because readmission rates substantially decrease after catheter insertion 10–12. Furthermore, in a study comparing IPC and TP in a propensity-matched design, not only the time spent in hospital peri-interventionally was shorter with IPC, but also readmission rates the year after were lower 13. Due to the retrospective character of our study, palliation could only be assessed in an indirect manner focusing on the need of additional (invasive) procedures like thoracenteses or (second) chest tubes.…”

Section: Discussionmentioning

confidence: 99%

“…The most common complications are infections and mechanical catheter problems. Rates of pleural infections are generally very low ranging below 6%,10–13 18 20 except for patients with liver cirrhosis and HH, where rates up to 16.7% have been described 21. As deep infections usually occur not earlier than 6 weeks after the procedure, ingestion of bacteria during catheter insertion is unlikely.…”

Section: Discussionmentioning

confidence: 99%

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Indwelling pleural catheters for non-malignant pleural effusions: report on a single centre’s 10 years of experience

et al. 2020

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BackgroundRecurrent pleural effusion is a common cause of dyspnoea, cough and chest pain during the course of infectious pleurisy and non-malignant diseases like congestive heart failure (CHF) or liver cirrhosis with hepatic hydrothorax (HH). With regard to the chronic character of the underlying diseases, indwelling pleural catheters (IPC) are increasingly used, not only assuring immediate symptom relief but also potentially leading to pleurodesis without sclerosing agents.Patients and methodsIn this single-centre retrospective observational study, patient characteristics, procedural variables and outcome in patients with IPC in non-malignant pleural effusion (NMPE) were evaluated and prognostic factors for pleurodesis were identified.ResultsFrom 2006 to 2017, 54 patients received 62 IPC, of whom 48.4% with CHF and 43.5% with HH. The median length of insertion was 1.5 months (IQR 0.6–2.9 months), the median survival time after insertion 3.2 months (IQR 1.1–16.0). An adequate symptom relief was achieved in 93.2% with no need for subsequent interventions. In patients surviving ≥30 days after IPC insertion, pleurodesis was observed in 45.9%, being associated to age (<55 years, p=0.02), the primary diagnosis (p=0.03) and interventions for the underlying disease (p<0.001). Complications occurred in 24.2% of all procedures (n=15), the majority concerning mechanical obstructions (n=10) and infections (n=4). Patients with HH had an excess risk for complications (37.3%).ConclusionEfficacy in symptom relief and a generally manageable safety profile recommend IPC as a first-line treatment option in NMPE, where disease-specific treatments are exhausted. Caution is warranted in patients with HH due to an excess risk for complications.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Indwelling pleural catheters for non-malignant pleural effusions: report on a single centre’s 10 years of experience

et al. 2020

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“…In these circumstances, recurrent therapeutic thoracentesis or occasionally talc pleurodesis may be attempted. Several small case series have reported good outcomes with talc pleurodesis in this context (3)(4)(5) despite some concerns regarding the possibility of translocating the fluid to another anatomical location (6). Medical thoracoscopy for administration of talc to achieve pleurodesis is an available option for patients with refractory pleural effusion (11).…”

Section: Discussionmentioning

confidence: 99%

“…Occasionally, patients have recurrent symptomatic pleural effusions despite optimal medical management, or medical therapy is limited due to other complications such as low blood pressure, syncope, or worsening renal function. Available options for such patients include repeated therapeutic thoracentesis or drainage and pleurodesis (talc poudrage or slurry) (3)(4)(5)(6). Alternatively, a tunneled pleural catheter can be considered in such a population (7).…”

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confidence: 99%

Tunneled Pleural Catheter Placement with and without Talc Poudrage for Treatment of Pleural Effusions Due to Congestive Heart Failure

et al. 2016

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This single-center, retrospective study demonstrated the feasibility of catheter placement used alone or with talc poudrage for the treatment of refractory pleural effusions associated with congestive heart failure. The addition of talc poudrage might increase the pleurodesis rate and reduce the days to catheter removal in highly selected patients. Prospective studies on a larger number of patients are warranted to verify the safety and efficacy of this intervention.

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“…include recurrent thoracentesis, which may be unpredictable in terms of frequency and complication, or pleurodesis, which typically requires hospitalization and may be associated with recurrent procedures and symptoms. 9 In this article, we review IPC placement for NMPE. We do not discuss benefits of repeated thoracentesis or pleurodesis in this population, although both have merits and have been successful.…”

mentioning

confidence: 99%

Indwelling Pleural Catheter Placement for Nonmalignant Pleural Effusions

Bramley

DeBiasi

Puchalski

2018

Semin Respir Crit Care Med

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Pleural effusions account for significant symptoms and morbidity. Recent studies demonstrate a high mortality in patients with “benign” pleural effusions, now better characterized as nonmalignant pleural effusions (NMPEs) based on their prognosis. The most common nonmalignant clinical conditions with recurrent pleural effusions are congestive heart failure and hepatic hydrothorax, although many other diseases exist in isolation or as comorbid conditions. When conventional therapy fails, thoracentesis is often performed for relief of dyspnea. Many times, however, the effusions recur despite maximal medical therapy. Placement of tunneled or indwelling pleural catheters provides an effective therapeutic strategy for recurrent NMPEs when other medical therapy fails.

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A Propensity-Matched Comparison of Pleurodesis or Tunneled Pleural Catheter for Heart Failure Patients With Recurrent Pleural Effusion

Cited by 33 publications

References 11 publications

Indwelling pleural catheters for non-malignant pleural effusions: report on a single centre’s 10 years of experience

Indwelling pleural catheters for non-malignant pleural effusions: report on a single centre’s 10 years of experience

Tunneled Pleural Catheter Placement with and without Talc Poudrage for Treatment of Pleural Effusions Due to Congestive Heart Failure

Indwelling Pleural Catheter Placement for Nonmalignant Pleural Effusions

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