Indwelling pleural catheters for benign pleural effusions: a concise review

Matta, Atul

doi:10.1097/mcp.0000000000000926

Cited by 2 publications

(2 citation statements)

References 25 publications

(36 reference statements)

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“…A few, single-center, small sample size studies show that spontaneous pleurodesis is achieved in about 40% of these patients after a median of 2 months. 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.…”

Section: Interventional Proceduresmentioning

confidence: 99%

Expert Review on Contemporary Management of Common Benign Pleural Effusions

Porcel

2023

Semin Respir Crit Care Med

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Heart failure (HF) and cirrhosis are frequently associated with pleural effusions (PEs). Despite their apparently benign nature, both HF-related effusions and hepatic hydrothorax (HH) have poor prognosis because they represent an advanced stage of the disease. Optimization of medical therapy in these two entities involve not only the use of diuretics, but also other pharmacological therapies. For instance, all HF patients with reduced or mildly reduced left ventricular ejection fraction can benefit from angiotensin receptor–neprilysin inhibitors, beta blockers, mineralocorticoid receptor antagonists, and sodium-glucose cotransporter 2 inhibitors. Conversely, it is better for HH patients to avoid nonselective beta blockers. Refractory cardiac- and cirrhosis-related PEs are commonly managed by iterative therapeutic thoracentesis. When repeated aspirations are needed, thereby diminishing quality of life, the insertion of an indwelling pleural catheter (IPC) may be warranted. However, in selected HH patients who are diuretic-resistant or diuretic-intractable, placement of transjugular intrahepatic portosystemic shunts should be considered as a bridge to liver transplantation, whereas in transplant candidates the role of IPC is debatable. Another benign condition, pleural tuberculosis (TB) is a serious health problem in developing countries. Diagnostic certainty is still a concern due to the paucibacillary nature of the infection, although the use of more sensitive nucleic acid amplification tests is becoming more widespread. Its treatment is the same as that of pulmonary TB, but the potential drug interactions between antiretroviral and anti-TB drugs in HIV-coinfected patients as well as the current recommended guidelines for the different types of anti-TB drugs resistance should be followed.

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Section: Interventional Proceduresmentioning

confidence: 99%

Expert Review on Contemporary Management of Common Benign Pleural Effusions

Porcel

2023

Semin Respir Crit Care Med

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“…5 6 7 Use of IPC is growing rapidly for patients with refractory benign pleural effusions as well. 8…”

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confidence: 99%

Indwelling Pleural Catheter: Management of Complications

Sidhu

Davies

Muruganandan

et al. 2023

Semin Respir Crit Care Med

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Multiple randomized clinical trials have established the advantages of indwelling pleural catheter (IPC) in the management of malignant pleural effusions, resulting in its widespread adoption in clinical practice. Complications can occur with IPC use and must be recognized and managed effectively. This review provides a comprehensive overview of IPC complications and their best care. Pain postinsertion or during drainage of IPC is easily manageable and must be distinguished from tumor-related chest wall pain. IPC-related infections require systemic antibiotics and often intrapleural fibrinolytic/deoxyribonuclease therapy. The removal of IPC for infection is usually unnecessary. Symptomatic loculation usually responds to fibrinolytics but may recur. Catheter tract metastases are common in mesothelioma patients and usually respond to radiotherapy without inducing damages to the IPC. Less common complications include dislodgement, irreversible blockage, and fractures (upon removal) of the catheter. Recommendations on the management of IPC complications by recent consensus statement/guideline are discussed. Expert opinions on management approaches are included in areas where evidence is lacking to guide care.

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Indwelling pleural catheters for benign pleural effusions: a concise review

Cited by 2 publications

References 25 publications

Expert Review on Contemporary Management of Common Benign Pleural Effusions

Expert Review on Contemporary Management of Common Benign Pleural Effusions

Indwelling Pleural Catheter: Management of Complications

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