Indwelling Pleural Catheters in Hepatic Hydrothorax

Kniese, Christopher; Diab, Khalil; Ghabril, Marwan; Bosslet, Gabriel T.

doi:10.1016/j.chest.2018.07.001

Cited by 37 publications

(19 citation statements)

References 34 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In the retrospective study of 62 patients by Kniese et al two patients who were listed for transplant died secondary to IPC-related empyema. This study described an 18% incidence of pleural infection ( 22 ). The single centre prospective feasibility study by Chen et al found pleural infection rates of 16%, however with no associated mortality ( 21 ).…”

Section: Discussionmentioning

confidence: 90%

“…The retrospective study by Kniese et al showed a small downward trend in albumin and BMI in their cohort of patients ( 22 ). It is unclear if replacement of pleural fluid with HAS, might reduce nutritional or electrolyte derangement ( 26 ).…”

Section: Discussionmentioning

confidence: 95%

“…A single-centre prospective feasibility study of 25 prospective liver transplant candidates who underwent IPC insertion for hepatic hydrothorax included five patients who went on to have liver transplantation ( 21 ). A retrospective review of sixty-two patients over a 10 year period who underwent IPC insertion for hepatic hydrothorax at a single referral centre, included ten patients who were bridged successfully to liver transplantation ( 22 ). The only multicentre retrospective review of use of IPC in hepatic hydrothorax included four patients who underwent liver transplantation ( 23 ).…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Case Report: Indwelling Pleural Catheter Based Management of Refractory Hepatic Hydrothorax as a Bridge to Liver Transplantation

et al. 2021

View full text Add to dashboard Cite

Introduction: Liver transplantation is the treatment of choice for decompensated liver disease, and by extension for hepatic hydrothorax. Persistent pleural effusions make it challenging for patients to maintain physiological fitness for transplantation. Indwelling pleural catheters (IPCs) provide controlled pleural fluid removal, including peri-operatively. The immune dysfunction of cirrhosis heightens susceptibility to bacterial infection and concerns exist regarding the sepsis potential from a tunnelled drain.Method: Six patients were identified who underwent IPC insertion for hepatic hydrothorax before successful liver transplantation, between November 2016 and November 2017.Results: All patients had recurrent transudative right sided pleural effusions. Mean age was 49 years (range 24–64) and mean United Kingdom Model for End-Stage Liver Disease score was 58. Four patients required correction of coagulopathy before insertion. There were no complications secondary to bleeding. Three patients were taught self-drainage at home of up to 1 litre (L) daily. A protocol was developed to ensure weekly review, pleural fluid culture and drainage of larger volumes in hospital. For every 2–3 L of pleural fluid drained, 100 mls of 20% Human Albumin Solution (HAS) was administered. On average an IPC was in situ for 58 days before surgery and drained 19 L of fluid in hospital. There was a small increase in average BMI (0.2) and serum albumin (2.1 g/L) at transplantation. There was one episode of stage one acute kidney injury secondary to high volume drainage. No further ascitic or pleural procedures were needed while an IPC was in situ. One thoracentesis was required after IPC removal. On average IPCs remained in situ for 7 days post transplantation and drained a further 2 L of fluid. Pleural fluid sampling was acquired on 92% of drainages in hospital. Of 44 fluid cultures, 2 cultured bacteria. Two patients had their IPCs and all other lines removed post transplantation due to suspected infection.Conclusion: Our case series describes a novel protocol and successful use of IPCs in the management of refractory hepatic hydrothorax as a bridge to liver transplantation. The protocol includes albumin replacement during pleural drainage, regular clinical review and culture of pleural fluid, with the option of self-drainage at home.

show abstract

Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Case Report: Indwelling Pleural Catheter Based Management of Refractory Hepatic Hydrothorax as a Bridge to Liver Transplantation

et al. 2021

View full text Add to dashboard Cite

show abstract

“…Als eine mögliche Option wurden getunnelte Pleurakatheter in zwei aktuellen retrospektiven Studien bei 79 bzw. 62 Patienten mit HH untersucht [4,5]. Die Schwierigkeit der getunnelten Katheter stellte die hohe Rate an Infektionen dar, die in 10% bzw.…”

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

“…Die Schwierigkeit der getunnelten Katheter stellte die hohe Rate an Infektionen dar, die in 10% bzw. 16,1% der Fälle beobachtet wurden und mit einer relevanten Mortalität verbunden sind [4,5]. Bei Kontraindikationen für eine TIPS-Anlage kann eine videoassistierte Thorakoskopie mit Pleurodese und/oder Verschluss diaphragmaler Lücken in Erwägung gezogen werden, wobei hierzu die Datenlage bezüglich langfristiger Therapieeffekte und Mortalität begrenzt ist [1].…”

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

Erhöhtes Komplikationsrisiko bei wiederholten Punktionen eines hepatischen Hydrothorax

Keymel¹

2019

Kompass Pneumol

View full text Add to dashboard Cite

Background: Repeat thoracentesis for symptom control is offered to patients with refractory hepatic hydrothorax (HH) but the risk profile for this management strategy remains unclear. Objectives: This study aimed to compare complication frequency and nature during repeat thoracentesis in patients with and without HH. Methods: Complication rates in patients undergoing repeat thoracentesis for symptom relief was compared between patients with HH and a control group (non-HH group) at a single center from 2010 to 2015. Records were reviewed for demographics, laboratory values, number of thoracentesis, and associated complications with each procedure. Results: 82 patients with HH (274 thoracenteses) and 100 control patients (188 thoracenteses) were included. A complication was noted in 17/462 (0.03%) procedures in the entire cohort. There was a higher overall complication rate with repeat thoracentesis in the HH group (8 vs. 0%, p = 0.016, 95% CI = 1.5-14.6). In the HH group, the cumulative risk of complications increased with sequential thoracenteses; a complication occurring in the preceding intervention was the strongest predictor for subsequent complication (OR = 17.1, p = 0.0013) and more than 1 previous complication was associated with a 15-fold increased risk of a subsequent complication (p < 0.001). In multivariate analysis within the HH group, the Model for End-Stage Liver Disease (MELD) score was an independent predictor of hemothorax (OR = 1.19, 95% CI = 1.03-1.36, p = 0.012). Conclusions: Repeat thoracentesis is an overall low-risk procedure, although a higher complication rate is observed in HH compared with non-HH patients. The presence of a previous complication significantly increases the risk of future complications in the HH population.

show abstract

Palliative Interventions in Patients With Cirrhosis With Refractory Ascites and Hepatic Hydrothorax: Who, What, and When?

Olson

2020

Clinical Liver Disease

View full text Add to dashboard Cite

show abstract

Indwelling Pleural Catheters in Hepatic Hydrothorax

Cited by 37 publications

References 34 publications

Case Report: Indwelling Pleural Catheter Based Management of Refractory Hepatic Hydrothorax as a Bridge to Liver Transplantation

Case Report: Indwelling Pleural Catheter Based Management of Refractory Hepatic Hydrothorax as a Bridge to Liver Transplantation

Erhöhtes Komplikationsrisiko bei wiederholten Punktionen eines hepatischen Hydrothorax

Palliative Interventions in Patients With Cirrhosis With Refractory Ascites and Hepatic Hydrothorax: Who, What, and When?

Contact Info

Product

Resources

About