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

Abstract

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.

Hepatic Hydrothorax: A Narrative Review

“…However, there is a growing body of research investigating the role of IPCs in addressing patient-centered symptoms associated with non-malignant effusions. Retrospective case series have shown pleurodesis success rates of 11 and 51% following IPC insertion [57][58][59][60][61][62], and also attest to the use of IPC as a bridge to liver transplant in refractory HH [58][59][60]. Infection rates were between 5 and 35%, with associated mortality (where reported) between 0 and 3.2% [57][58][59][60][61][62].…”

“…Retrospective case series have shown pleurodesis success rates of 11 and 51% following IPC insertion [57][58][59][60][61][62], and also attest to the use of IPC as a bridge to liver transplant in refractory HH [58][59][60]. Infection rates were between 5 and 35%, with associated mortality (where reported) between 0 and 3.2% [57][58][59][60][61][62]. Notably, Walker et al performed the only randomized controlled trial to date of IPCs in refractory transudative effusions [63].…”

Indwelling pleural catheters for benign pleural effusions: a concise review

“…Multiple other studies looking into the efficacy and safety of IPCs in BPE had a majority of patients with CHF (Table 1) [17 ▪ ], including the most recent randomized control trial by Walker et al [9 ▪▪ ]. They recruited a total of 68 patients with refractory transudative effusion, of which 46 patients had CHF as the underlying cause.…”

Thoracentesis, Chest Tubes, and Tunneled Chest Drains

“…23 Other studies have validated the effectiveness of tunneled pleural drains for nonmalignant pleural effusions, with variable rates of spontaneous pleurodesis. 24 Given the developing data, we advise against placing tunneled pleural drains for infection. For other nonmalignant causes, the decision should be multidisciplinary and align with the goals of care of the patient.…”