Outpatient management of malignant pleural effusion with chronic pleural catheter

Díez-Porres, Leyre; Alonso-Babarro, Alberto; Iglesias-Docampo, A; Díaz-Agero, Prudencio

doi:10.1177/0269216308095020

Cited by 10 publications

(7 citation statements)

References 8 publications

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“…Intermittent external drainage through indwelling pleural catheters is gaining popularity, because indwelling pleural catheters can be inserted as an outpatient procedure and offer rapid relief of dyspnea through ambulatory drainage of MPE [53], [54]. The results of this meta-analysis demonstrated that both talc pleurodesis and indwelling catheters were effective initial treatments for controlling MPE with similar success.…”

Section: Discussionmentioning

confidence: 91%

Efficacy and Safety of Talc Pleurodesis for Malignant Pleural Effusion: A Meta-Analysis

et al. 2014

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BackgroundTalc pleurodesis has been widely used to control malignant pleural effusion; however, it is still not clear whether talc pleurodesis is more effective than other local therapies. We performed a meta-analysis to evaluate the efficacy and safety of talc pleurodesis in the management of malignant pleural effusion.MethodsPubMed, Embase, and Web of Science were searched for English-language studies of clinical controlled trials comparing talc pleurodesis with control therapies until August 8, 2013. Success rate and incidence of adverse events were evaluated. Relative risks were estimated using random- or fixed- effects model and statistical heterogeneity was assessed using I2 test.ResultsTwenty trials involving 1,525 patients with malignant pleural effusion were included. The success rate of talc pleurodesis was significantly higher than that of control therapies (relative risk, 1.21; 95% confidence interval, 1.01–1.45; p = 0.035) with similar adverse events. In addition, thoracoscopic talc poudrage was more effective than bedside talc slurry (relative risk, 1.12; 95% confidence interval, 1.01–1.23; p = 0.026).ConclusionsThe current evidences suggested the benefit for talc pleurodesis in the treatment of malignant pleural effusion. Talc pleurodesis, especially thoracoscopic talc poudrage pleurodesis, should be performed in patients with malignant pleural effusion, especially those with life-expectancy longer than one month.

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Section: Discussionmentioning

confidence: 91%

Efficacy and Safety of Talc Pleurodesis for Malignant Pleural Effusion: A Meta-Analysis

et al. 2014

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“…Three meeting abstracts10,17,18 and one letter19 were eligible and presented sufficient data to be included in the analysis. Eight studies were conducted outside the USA.…”

Section: Resultsmentioning

confidence: 99%

“…62% of TIPC inserted during VATSLung 33, breast 19, mesothelioma 42, other 31Bertolaccini,10 200977Unknown setting in Italy. Patients with at least 1 prior thoracentesisLung 37, breast 15, mesothelioma 15, colon 7, pancreas 2, ovarian 1Diez-Porres,19 20088Palliative home care unit affiliated with public hospital in Spain. Unknown prior treatment for MPELung 3, breast 1, mesothelioma 1, RCC 2, other 1Mullett,17 200370Academic center in the USA.…”

Section: Resultsmentioning

confidence: 99%

Efficacy and Safety of Tunneled Pleural Catheters in Adults with Malignant Pleural Effusions: A Systematic Review

2010

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BackgroundMalignant pleural effusions (MPE) are a frequent cause of dyspnea and discomfort at the end of cancer patients' lives. The tunneled indwelling pleural catheter (TIPC) was approved by the FDA in 1997 and has been investigated as a treatment for MPE.ObjectiveTo systematically review published data on the efficacy and safety of the TIPC for treatment of MPE.DesignWe searched the MEDLINE, EMBASE, and ISI Web of Science databases to identify studies published through October 2009 that reported outcomes in adult patients with MPE treated with a TIPC. Data were aggregated using summary statistics when outcomes were described in the same way among multiple primary studies.Main MeasuresSymptomatic improvement and complications associated with use of the TIPC.Key ResultsNineteen studies with a total of 1,370 patients met criteria for inclusion in the review. Only one randomized study directly compared the TIPC with the current gold standard treatment, pleurodesis. All other studies were case series. Symptomatic improvement was reported in 628/657 patients (95.6%). Quality of life measurements were infrequently reported. Spontaneous pleurodesis occurred in 430/943 patients (45.6%). Serious complications were rare and included empyema in 33/1168 patients (2.8%), pneumothorax requiring a chest tube in 3/51 (5.9%), and unspecified pneumothorax in 17/439 (3.9%). Minor complications included cellulitis in 32/935 (3.4%), obstruction/clogging in 33/895 (3.7%) and unspecified malfunction of the catheter in 11/121 (9.1%). The use of the TIPC was without complication in 517/591 patients (87.5%).ConclusionsBased on low-quality evidence in the form of case series, the TIPC may improve symptoms for patients with MPE and does not appear to be associated with major complications. Prospective randomized studies comparing the TIPC to pleurodesis are needed before the TIPC can be definitively recommended as a first-line treatment of MPE.

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“…[36][37][38] In the published data where occlusion rates were recorded, only 29 out of 624 (4.6%) catheters had blockage requiring an intervention at some point in the time that the catheter was in situ. 32,35,36,[38][39][40][41][42][43][44] Therefore, these data provide further evidence against the need for large-bore tubes in patients with pleural cancers. PNEUMOTHORAX Small-bore chest drains have a well established role in the management of primary, secondary, and iatrogenic pneumothorax.…”

Section: Malignant Pleural Effusionmentioning

confidence: 97%

Optimal Chest Drain Size: The Rise of the Small-Bore Pleural Catheter

Fysh

Smith

Lee

2010

Semin Respir Crit Care Med

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Drainage of the pleural space is not a modern concept, but the optimal size of chest drains to use remains debated. Conventional teaching advocates blunt dissection and large-bore tubes; but in recent years, small-bore catheters have gained popularity. In the absence of high-quality randomized data, this review summarizes the available literature on the choice of chest drains. The objective data supporting the use of large-bore tubes is scarce in most pleural diseases. Increasing evidence shows that small-bore catheters induce less pain and are of comparable efficacy to large-bore tubes, including in the management of pleural infection, malignant effusion, and pneumothoraces. The onus now is on those who favor large tubes to produce clinical data to justify the more invasive approach.

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Outpatient management of malignant pleural effusion with chronic pleural catheter

Cited by 10 publications

References 8 publications

Efficacy and Safety of Talc Pleurodesis for Malignant Pleural Effusion: A Meta-Analysis

Efficacy and Safety of Talc Pleurodesis for Malignant Pleural Effusion: A Meta-Analysis

Efficacy and Safety of Tunneled Pleural Catheters in Adults with Malignant Pleural Effusions: A Systematic Review

Optimal Chest Drain Size: The Rise of the Small-Bore Pleural Catheter

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