Effect of an Indwelling Pleural Catheter vs Talc Pleurodesis on Hospitalization Days in Patients With Malignant Pleural Effusion

Thomas, Rajesh; Fysh, Edward; Smith, Nicola; Lee, Pyng; Kwan, Benjamin; Yap, Elaine; Horwood, Fiona; Piccolo, Francesco Lo; Lam, David; Garske, Luke; Shrestha, Rabindra Man; Kosky, Christopher; Read, Catherine; Murray, Kevin; Lee, Y. C. Gary

doi:10.1001/jama.2017.17426

Cited by 197 publications

(226 citation statements)

References 35 publications

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“…IPC use is increasing with the increasing number of high quality clinical studies and randomized trials providing evidence of efficacious use [1,2], in both malignant and non-malignant disease [4,10]. While it is now established that in MPE, IPC and talc pleurodesis have similar beneficial effects on important patient outcomes such as breathlessness [1], the majority of studies have focused on short term, hospital focused outcomes such as hospital stay.…”

Section: Discussionmentioning

confidence: 99%

“…Since published randomized data demonstrated similar symptomatic improvement using IPC or talc pleurodesis in MPE [1], standard practice in the Oxford Pleural Unit is to offer patients a choice between talc pleurodesis and IPC insertion. Two randomized trials demonstrated that IPCs avoid hospital stay in MPE, and are therefore an increasingly attractive option for patients wishing to avoid hospitalization [1,2]. However, there is a lack of evidence about the overall impact of IPCs on patients and hospital visits beyond the initial insertion procedure done as a day case procedure, and usual scheduled outpatient visits.…”

Section: Introductionmentioning

confidence: 99%

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The Hospital and Patient Burden of Indwelling Pleural Catheters: A Retrospective Case Series of 210 Indwelling Pleural Catheter Insertions

et al. 2018

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Background: Indwelling pleural catheters (IPC) offer an alternative to talc pleurodesis in recurrent effusion, especially in patients wishing to avoid hospitalization. Two randomized trials have demonstrated reduced time in hospital using IPCs versus talc pleurodesis in malignant pleural effusion (MPE). However, the impact of IPCs on hospital services and patients has not been well studied. Objectives: To analyze long-term outcomes of IPCs and understand the hospital burden in terms of requirement for hospital visits and contacts with healthcare, while the IPC was in situ. Methods: IPC insertions in a tertiary pleural center were analyzed retrospectively. Reviews of patients with IPCs in situ considered “additional” to routine clinical follow-up were defined pre-hoc. Results: A total of 202 cases were analyzed: 89.6% MPE group (n = 181) and 10.4% non-MPE group (n = 21). There were a median 3.0 (interquartile range [IQR] 3) and 2.0 (IQR 2) ipsilateral pleural procedures prior to each IPC insertion in non-MPE and MPE groups, respectively (p = 0.26), and a mean 1.3 (SD 1.7) planned IPC-related outpatient follow-up visits per patient. There were 2 (9.5%) and 14 (7.7%) IPC-related infections in non-MPE and MPE groups, respectively. Four (19.0%) and 44 (24.3%) patients required additional IPC-related reviews in non-MPE and MPE groups, respectively (p = 0.6), and these occurred within 250 days post IPC insertion. Conclusions: Although IPCs decrease initial length of hospital stay compared to talc pleurodesis via chest drain, IPCs are associated with significant hospital-visit burden, in addition to planned visits and regular home IPC drainages. IPC-using services need to be prepared for this additional work to run an IPC service effectively.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The Hospital and Patient Burden of Indwelling Pleural Catheters: A Retrospective Case Series of 210 Indwelling Pleural Catheter Insertions

et al. 2018

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“…Ein Vergleich einer Pleurodese via IPC gegenüber einer Thoraxdrainage ist aktuell Gegenstand einer klinischen Studie [3]. Die symptomatische Besserung, die durch einen IPC (ohne Pleurodese) erreicht werden kann, scheint hingegen vergleichbar mit einer Pleurodese via Thoraxdrainge [2,4]. Somit ist bei der Entscheidung IPC, IPC + Pleurodese oder Thoraxdrainage + Pleurodese das Therapieziel unter Berücksichtigung des Patientenwunsches und des Patientenmanagements genau zu definieren und das entsprechend geeignete Verfahren zu wählen.…”

Section: Transfer In Die Praxis Von Dr Stefanie Keymel (Düsseldorf)unclassified

“…Das durchschnittliche Alter der Patienten beträgt in dieser und anderen Studien, z.B. AMPLE [4], >60 Jahre. Fortgeschrittenes Alter sowie Begleiterkrankungen begünstigen eher ein nicht operatives Management.…”

Section: Transfer In Die Praxis Von Dr Stefanie Keymel (Düsseldorf)unclassified

Talkumpleurodese über dauerhaft implantierten Katheter bei malignem Pleuraerguss

Keymel¹

2019

Kompass Pneumol

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Ein maligner Pleuraerguss (MPE) wird häufig nicht operativ durch eine Talkumpleurodese behandelt, die typischerweise unter stationären Bedingungen vorgenommen wird. Als Behandlungsalternative kann ein Pleurakatheter (indwelling pleural catheter, IPC) zur intermittierenden Drainage implantiert werden. Dies kann als ambulante Prozedur vorgenommen werden. In einer klinischen multizentrischen Studie im Vereinigten Königreich wurde geprüft, ob die Instillation von Talkum über einen IPC häufiger zu einer Pleurodese führt als Plazebo. Hierfür wurden Patienten mit MPE eingeschlossen, bei denen nach Anlage eines IPC und Drainagetherapie die Lunge nach 10 Tagen entfaltet war. 69 Patienten wurde über den IPC 4g einer Talkumsuspension instilliert, 70 Patienten wurde als Plazebo über den IPC Kochsalzlösung appliziert. Der primäre Endpunkt, die erfolgreiche Pleurodese nach der Randomisierung, wurde bei 30 von 69 (43%) Patienten in der Talkumgruppe und 16 von 70 (23%) Patienten in der Plazebogruppe erreicht, dies war signifikant häufiger in der Talkumgruppe (Hazard ratio 2,20; 95% Konfidenzintervall 1,23-3,92; p = 0,008). Die Lebensqualität und die Symptomatik waren besser in der Talkumgruppe, während die Ergussmenge, die Anzahl der stationären Behandlungstage, die Mortalität oder der Anzahl von unerwünschten Ereignissen zwischen den Gruppen vergleichbar waren.

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“…The latter has the advantage of being used to either chronically drain the pleural space, or to facilitate chemical or autopleurodesis [3], and several studies have confirmed that the improvement in QoL and other patient-related outcomes are comparable between IPC with intermittent drainage, and intercostal drainage with pleurodesis. Further, patients managed with an IPC appear to spend less time in hospital, and are less likely to require a subsequent pleural procedure [7,8].The evidence for the use of IPCs is increasingly growing, and the ASAP trial, concluded that "aggressive" daily drainage significantly increased the rate of autopleurodesis, as compared to alternative day drainage, (47 vs. 24%, p = 0.003) as well as decreased the median time to autopleurodesis (54 vs. 90 days) in patients [9]. QoL and patient satisfaction were similar between the groups; however importantly, all cases with nonexpendable lung were excluded from this study [9].…”

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confidence: 99%

The Optimal Management of Malignant Pleural Effusion: Steady Progress Towards an Evidence-Based Approach

Koegelenberg¹,

Allwood²

2018

Respiration

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Effect of an Indwelling Pleural Catheter vs Talc Pleurodesis on Hospitalization Days in Patients With Malignant Pleural Effusion

Abstract: anzctr.org.au Identifier: ACTRN12611000567921.

Cited by 197 publications

References 35 publications

The Hospital and Patient Burden of Indwelling Pleural Catheters: A Retrospective Case Series of 210 Indwelling Pleural Catheter Insertions

The Hospital and Patient Burden of Indwelling Pleural Catheters: A Retrospective Case Series of 210 Indwelling Pleural Catheter Insertions

Talkumpleurodese über dauerhaft implantierten Katheter bei malignem Pleuraerguss

The Optimal Management of Malignant Pleural Effusion: Steady Progress Towards an Evidence-Based Approach

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