Incidence of complications from indwelling pleural catheter for pleural effusion: A meta‐analysis

Abstract

Indwelling pleural catheter (IPC) is widely used in patients with pleural effusion (PE). This meta‐analysis aimed to comprehensively summarize the clinical complication from IPC. We searched four large electronic databases (PubMed, EMBASE, MEDLINE, and Cochrane Library) for potentially relevant studies and assessed the included studies’ quality using the methodological index for nonrandomized studies’ criteria. Extracted data were used to pool rates, and to conduct subgroup and meta–regression analyses. Forty‐one studies involving a cumulative 4983 patients with 5650 IPCs were included in this meta‐analysis. The overall incidence of IPC complications was 20.3% (95% confidence interval [CI]: 15.0–26.3). The top four complications were: overall infection incidence 5.7% (95% CI: 0.7–2.4); overall catheter abnormality incidence 4.4% (95% CI: 2.8–6.3); pain incidence 1.2% (95% CI: 0.4–2.4); and overall loculation incidence 0.9% (95% CI: 0.1–2.1). Subgroup and meta‐regression analyses for overall complications and infections by country, PE site, and PE type demonstrated these factors did not contribute significantly to heterogeneity. Further subgroup analyses for infection of benign PE showed that the overall infection incidence (12.6% [95% CI: 8.1–17.8] vs 0.7% [95% CI: 0.0–4.5]) and empyema incidence (9.1% [95% CI: 5.3–13.8] vs 0.0% [95% CI: 0.0–2.3]) of patients with liver‐related PE were significantly higher than that of patients with heart‐related PE. Our meta‐analysis showed reliable pooled incidences of IPC‐related complications, with infection being the most common. These results serve to remind clinicians about the incidence of IPC‐related complications and emphasize the importance of taking corresponding preventive and therapeutic steps.

Indwelling Pleural Catheter: Management of Complications

“…40 Previous meta-analyses found blockage rates between 1.5 and 3.7% and leakage rates of approximately 0.6%. 9 13 Other studies have reported blockage rates up to 18.1% and leakage up to 2%. 40 41 Not surprisingly, these rates are higher if the IPC remains longer in situ.…”

“…Aforementioned meta-analyses found dislodgement rates of 2.2%. 9 13 Other series reported a wide range of incidence rates between 1.2 and 18%. 24 40 41 Once again, the incidence was greater in those with longer follow-up period, which had a rate of up to 33.3%.…”

“…These include pleural infection or empyema, wound site infection, and skin tract infection (cellulitis) with estimated incidences of 1.3% (95% confidence interval: 0.6–2.2), 0.4% (0.1–1.0), and 0.9% (0.3–1.7), respectively, from studies pooling infection rates reported in the literature. 9…”

“…The ability to troubleshoot and provide optimal care for any adverse events is essential to running successful ambulatory IPC drainage programs. 9 Yet, it is an area often overlooked and with limited data to guide best practices.…”

Expert Review on Contemporary Management of Common Benign Pleural Effusions

“…45,46 IPC-related infections develop in up to 12% of the cases. 47,48 In the only randomized trial on 68 refractory transudative PEs (46 with HF), where 21 HF patients were assigned to the IPC group and 25 to the TT group, the mean daily breathlessness score over 12 weeks from randomization was not significantly different in both branches. 49 More nonserious adverse events were noted in the IPC group (59 vs. 37%).…”