Effect of an Indwelling Pleural Catheter vs Chest Tube and Talc Pleurodesis for Relieving Dyspnea in Patients With Malignant Pleural Effusion

Davies, Helen; Mishra, Eleanor; Kahan, Brennan C; Wrightson, John; Stanton, Andrew; Guhan, Anur; Davies, Christopher W. H.; Grayez, Jamal; Harrison, Richard; Prasad, Anjani; Crosthwaite, Nicola; Lee, Gary; Davies, Robert J. O.; Miller, R F; Rahman, Najib M.

doi:10.1001/jama.2012.5535

Cited by 522 publications

(581 citation statements)

References 24 publications

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“…Placement of an IPC under local anaesthesia is a safe alternative and also improves the quality of life. Prior studies comparing talc poudrage vs. insertion of an IPC did not demonstrate a significant difference in performance score and improvement of quality of life [7].…”

Section: Discussionmentioning

confidence: 79%

“…However, there is a burden of on-going care such as wound dressing changes and drainages [12]. Nonetheless, according to the TIME2 trial this does not affect the quality of life in these patients [7]. The probability of spontaneous pleurodesis with an IPC insertion without additional talc poudrage lies between 26% and 76% [6,8,13].…”

Section: Discussionmentioning

confidence: 99%

“…Intermittent fluid drainage is needed until efficient pleurodesis occurs [6]. The use of IPCs improves the quality of life in patients [7]. The insertion of an IPC can reduce the hospitalization time in case of malignant pleural effusion since they can be inserted as an outpatient procedure [8].…”

Section: Introductionmentioning

confidence: 99%

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Management of Pleural Effusion by Combining Talc Poudrage and Indwelling Pleural Catheter: A Retrospective Single Center Study

Bg¹,

Schmid²,

Hoksch³

2017

J Clin Trial

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Objective: In 2013 we started to combine VATS poudrage with simultaneous insertion of an indwelling pleural catheter (IPC) for management of malignant pleural effusions (MPE) to achieve successful pleurodesis, avoid recurrence of MPE and shorten hospitalization time. The aim of this study was to distinguish whether the combination treatment is superior over standard VATS poudrage. Methods:This retrospective descriptive study analyses data of patients with MPE treated at our department since the implementation of the method. The historic control group included patients with MPE treated with VATS poudrage alone.Results: There were 117 patients, 67 patients were treated with the new approach (IPC group) and 50 patients with VATS talc poudrage (control group). Both groups were comparable in demographic data. The postoperative hospitalization time was significantly shorter in the IPC group (P=0.0001). Patients in the control group got 2 chest drains inserted (Ch 24/Ch 28) and in the IPC group 1 chest drain (Ch 24) plus the IPC. Chest drains could be removed quicker in the IPC group (P=<0.0001). So far there was not a single case of unsuccessful pleurodesis with our approach compared to 10% failure rate in the control group. Conclusion:The combined approach is a safe and effective approach in MPE prophylaxis. Patients were discharged earlier and further treatment, e.g., chemotherapy, could be initiated in time.

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Section: Discussionmentioning

confidence: 79%

Section: Discussionmentioning

confidence: 99%

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Management of Pleural Effusion by Combining Talc Poudrage and Indwelling Pleural Catheter: A Retrospective Single Center Study

Bg¹,

Schmid²,

Hoksch³

2017

J Clin Trial

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“…Pleurodesis: a comparison of two sclerosing agents for pleural effusions in Mozambique the puncture, pneumothorax, empyema, and loss of protein (2,3). The resulting protein depletion leads to a decrease in oncotic pressure and consequent new accumulation of fluid in the pleural space (2).…”

Section: Original Articlementioning

confidence: 99%

Pleurodesis: a comparison of two sclerosing agents for pleural effusions in Mozambique

Figueiredo¹,

Cossa²,

Hassane³

et al. 2017

J. Thorac. Dis.

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Background: Pleural effusions constitute one of the most frequent pathologies encountered in the pulmonary service of Maputo Central Hospital (MCH) in Mozambique. Bleomycin and talc are commonly used for pleurodesis, but cost prohibitive, therefore we aimed to retrospectively compare the efficacy and safety of sodium hydroxide (NaOH) with bleomycin for pleurodesis. Methods: Case records of pleurodesis using bleomycin and NaOH from 2002 to 2013 were reviewed.Standard of care for pleurodesis for recurrent pleural effusions at MCH was developed using the materials available. NaOH remained the agent of choice until 2006 when bleomycin became available. Clinical data regarding general complications, rate of success and lung expansion were noted for every patient who underwent pleurodesis at MCH during this time frame. Results: Review of pleurodesis at MCH revealed 24 cases using bleomycin and 23 cases using NaOH as the sclerosing agent. Patient characteristics were balanced between the two groups with majority of pleural effusions malignant in etiology. Conclusions: There was no statistically significant difference between the use of bleomycin and NaOH as defined by lung expansion. General complications were observed less frequently in 2 (10%) of patients treated with NaOH compared with 8 (38%) of patients using bleomycin. Only three patients presented with recurrent pleural effusion after pleurodesis with NaOH. NaOH may offer a low cost alternative sclerosing agent for resource limited areas.

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“…The management of malignant pleural effusions has seen considerable progress within the past decade, with a number of randomised controlled trials now informing practice [1][2][3]. This progress, by contrast, has not been mirrored in non-malignant pleural disease, which has an evidence base still formed largely of observational studies.…”

Section: Introductionmentioning

confidence: 99%

The management of benign non-infective pleural effusions

et al. 2016

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The evidence base concerning the management of benign pleural effusions has lagged behind that of malignant pleural effusions in which recent randomised trials are now informing current clinical practice and international guidelines.The causes of benign pleural effusions are broad, heterogenous and patients may benefit from individualised management targeted at both treating the underlying disease process and direct management of the fluid. Pleural effusions are very common in a number of non-malignant pathologies, such as decompensated heart failure, and following coronary artery bypass grafting. Pleural fluid analysis forms an important basis of the diagnostic evaluation, and more specific assays and imaging modalities are helpful in specific subpopulations.Options for management beyond treatment of the underlying disorder, whenever possible, include therapeutically aspirating the fluid, talc pleurodesis and insertion of an indwelling pleural catheter. Randomised trials will inform clinicians in the future as to the risks and benefits of these options providing a guide as to how best to manage patient symptoms in this challenging clinical setting. @ERSpublications Benign pleural effusion management is challenging and based on limited evidence. Treatment options are discussed http://ow.ly/10EOSN

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Effect of an Indwelling Pleural Catheter vs Chest Tube and Talc Pleurodesis for Relieving Dyspnea in Patients With Malignant Pleural Effusion

Cited by 522 publications

References 24 publications

Management of Pleural Effusion by Combining Talc Poudrage and Indwelling Pleural Catheter: A Retrospective Single Center Study

Management of Pleural Effusion by Combining Talc Poudrage and Indwelling Pleural Catheter: A Retrospective Single Center Study

Pleurodesis: a comparison of two sclerosing agents for pleural effusions in Mozambique

The management of benign non-infective pleural effusions

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