The Role for Tunneled Indwelling Pleural Catheters in Patients With Persistent Benign Chylothorax

DePew, Zachary S.; Iqbal, Seher; Mullon, John J.; Maldonado, Fabien; Nichols, Francis C.

doi:10.1097/maj.0b013e31827b936c

Cited by 38 publications

(19 citation statements)

References 17 publications

(17 reference statements)

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“…A recent review of previously published data revealed that management of a benign pleural effusion with a TIPC was well tolerated in the majority of patients with a low complication rate, and spontaneous pleurodesis in some patients [51]. Several subsequent reports have supported previous data demonstrating improved clinical outcomes for patients with benign effusions along with a reasonable safety profile [52][53][54]. Additional research is needed before TIPCs are widely recommended for the management of refractory benign pleural effusions, but results thus far are encouraging.…”

Section: Tunneled Indwelling Pleural Cathetersmentioning

confidence: 85%

The role of interventional therapy for pleural diseases

DePew

Maldonado²

2014

Expert Review of Respiratory Medicine

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Pleural diseases encompass a vast and heterogeneous group of diseases that have traditionally received relatively little attention from researchers, resulting in empiric approaches to patient management based largely on expert opinions and anecdotal evidence. Yet, paradoxically, pleural diseases represent a considerable burden for patients, providers, and the healthcare system as a whole, with a rising incidence of malignant pleural effusions and pleural space infections, in increasingly complex patients. Fortunately, the last decade has witnessed unprecedented research efforts from the pleural community, which have resulted in substantial advances in risk-stratification, patient selection, treatment efficacy and the development of evidence-based recommendations ultimately leading to improved patient care. In this review, we will present a summary of the current evidence for the management of pleural diseases with an emphasis on interventional procedures, and highlight the need for future research efforts in the field of malignant pleural effusions, pleural space infections and pneumothorax.

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Section: Tunneled Indwelling Pleural Cathetersmentioning

confidence: 85%

The role of interventional therapy for pleural diseases

DePew

Maldonado²

2014

Expert Review of Respiratory Medicine

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“…Ismételt thoracocentesist általában csak akkor végeznek, ha az alapbetegség rövid távú kezelésétől javulást várnak vagy a klinikai tü-netek kis foka csak időnkénti aspirációt igényel. Nagy volumenű vagy különösen a már szimptómás chylothorax esetén a folyamatos drenálásnak kell következnie [19,22,31].…”

Section: Konzervatív Kezelésunclassified

“…Utolsó sebészi lehetőségként pleuroperitonealis sönt vagy állandó drenázs (5. ábra) képzése megfelelő "alagutas" katéterrendszer behelyezésével megfontolható [31,72].…”

Section: Sebészi Kezelésunclassified

A chylothorax modern kezelésének bizonyítékalapú áttekintése

2016

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A chylothorax napjainkban rendszerint műtéti vagy baleseti szövődmény, ritkábban daganat következménye. Prospektív vagy randomizált vizsgálatok hiányában a bizonyítékalapú kezelés személyes tapasztalaton, ideálisan a retrospektív elemzések ismeretében történik. A szerzők célja a chylothorax modern kezelésének áttekintése. A PubMed adatbázist "chylothorax" kulcsszóra szűrték az elmúlt tíz év közleményei között, kiemelve az összehasonlító értéke-léseket. A módszerek és ajánlások kritikai elemzésekor a szerzők együttes 39 éves klinikai tapasztalatukra támaszkod-tak. A konzervatív kezelés sikere az etiológiától függően nagy szórást mutat (3-90%). A non-és szemi-invazív intervenciós eljárások sikerrátája 50-100% közötti. Eredménytelen konzervatív kezeléskor a sebészi kezelés, elsősorban a ductus thoracicus lekötése jelenti a standard terápiát. Ezen beavatkozások sikerességi aránya 64-100% közötti, a morbiditási/mortalitási mutató elérheti a 25%-ot. A kezelést konzervatívan kell megkezdeni, majd egy lépcsőzetes agresszivitású terápia ajánlott, amelyben a beteg állapota és a drénvolumen irányítják a döntéshozatalt. Az intervenciós radiológiai eljárások biztonságosak, sikeresek és helyet kaptak a konzervatív és műtéti megoldások mellett. Orv. Hetil., 2016, 157(2), 43-51. Kulcsszavak: chylothorax, szövődmény, mellkassebészet Review of evidence-based modern treatment for chylothoraxChylothorax is a multi-factorial complication, frequently of an operation or an accident, but rarely of a tumour. In the absence of prospective or randomised studies evidence-based treatment is normally based on personal experience, ideally in the possession of retrospective analyses using the "best practice" method. The aim of the authors was the review the up-to-date chylothorax treatments. They performed the PubMed database's "chylothorax" keyword search of the publications reported in the last ten years. They put emphasis on articles that included a comparative analysis of the various treatment options. During the critical analysis of the methods and recommendations, the authors relied on their own joint experience amounting to 39 years. The results showed that the success of the initial conservative treatment indicates a signifi cant deviation depending on the etiology (3-90%). The success rate of noninvasive or semi-invasive interventions is between 50-100%, again depending on the etiology. The standard surgical treatment following an unsuccessful conservative treatment of an operable patient includes the fi tting of a (thoracoscopic) knot to the ductus thoracicus, pleurodesis, insertion of a permanent chest drain or a pleuroperitoneal shunt. The success rate of these interventions is between 64-100%, with a morbidity index and mortality index exceeding 25%. Conservative treatment should be the fi rst step, which should then be followed by a gradually increased aggressive therapy, during which the decisions should be made according to the patient's condition and the drain volume. Interventional radiology procedures are safe, successful an...

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“…Evidence also now exists to suggest they can be used to manage many other conditions, including non-malignant recurrent effusions [11], chylothorax [12,13], loculated effusions [14], and even empyema [15] and haemothorax [16], although manufacturers still view some of these as contraindications [17]. Absolute contraindications include an inability for the patient, family or healthcare services to manage or tolerate the drain; uncorrected coagulopathy; pleural infection with evidence of ongoing sepsis, and evidence of cutaneous infection or significant malignant involvement over the proposed insertion site.…”

Section: Ipc Insertion and Drainagementioning

confidence: 99%

Indwelling Pleural Catheters

Bhatnagar

Maskell²

2014

Respiration

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Indwelling pleural catheters (IPC) are now established as one of the major tools for the management of recurrent pleural effusions. Their traditional role, which saw them only as second line treatment for malignant effusions, has now expanded. Recent evidence has not only suggested that they may be effectively employed as first-line therapy in some malignant cases, but that there is a wider spectrum of diseases which may be managed by their use. The majority of patients are likely to experience symptomatic benefit and some may also go on to achieve pleurodesis. IPCs are relatively simple to insert and maintain, and theoretically allow patients to be managed entirely as an outpatient, meaning that they are likely to be cost-effective in the longer term. They can also dramatically improve the quality of life in patients who have typically needed lengthy hospital admissions or who have terminal malignant disease.

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The Role for Tunneled Indwelling Pleural Catheters in Patients With Persistent Benign Chylothorax

Cited by 38 publications

References 17 publications

The role of interventional therapy for pleural diseases

The role of interventional therapy for pleural diseases

A chylothorax modern kezelésének bizonyítékalapú áttekintése

Indwelling Pleural Catheters

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