Treatment of Malignant Pleural Effusions with Tunneled Long-term Drainage Catheters

Pollak, Jeffrey; Burdge, Catherine M.; Rosenblatt, Melvin; Houston, John; Hwu, Wen Jen; Murren, John R.

doi:10.1016/s1051-0443(07)61826-0

Cited by 88 publications

(65 citation statements)

References 18 publications

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“…In one study, results indicate that there may be no difference between large and small tubes [51]. This is supported by evidence found in non-randomised studies [62][63][64][65][66][67][68][69][70]. These studies included patients in whom the tube was placed under image guidance and/or outpatient drain management protocols were employed.…”

Section: Discussionmentioning

confidence: 89%

The evidence on the effectiveness of management for malignant pleural effusion: a systematic review

Tan

Sedrakyan

Browne

et al. 2006

European Journal of Cardio-Thoracic Surgery

230

119

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The aim of this study was to review systematically the available evidence on pleurodesis for malignant effusion, focusing on the choice of the agents, route of delivery and other strategies to improve outcomes. Four electronic databases (MEDLINE, EMBASE, Web of Science and Cochrane Controlled Trials Register) were searched, reference lists checked and letters requesting details of unpublished trials and data sent to authors of previous trials. Studies of malignant pleural effusion in humans were selected with no language restrictions applied. Criteria for randomised clinical trial (RCT) eligibility were random allocation of patients and non-concurrent use of another experimental medication or device. Methodological quality evaluation of the trials was based on randomisation, blinding, allocation concealment and intention to treat analysis. A random effect model was used to combine the relative risk estimates of the treatment effects whenever pooling for an overall effect was considered appropriate. Forty-six RCTs with a total of 2053 patients with malignant pleural effusions were reviewed for effectiveness of pleurodesis. Talc tended to be associated with fewer recurrences when compared to bleomycin (RR, 0.64; 95% CI, 0.34-1.20) and, with more uncertainty, to tetracycline (RR, 0.50; 95% CI, 0.06-4.42). Tetracycline (or doxycycline) was not superior to bleomycin (RR, 0.92; 95% CI, 0.61-1.38). When compared with bedside talc slurry, thoracoscopic talc insufflation was associated with a reduction in recurrence (RR, 0.21; 95% CI, 0.05-0.93). Strategies such as rolling the patient after instillation of the sclerosing agent, protracted drainage of the effusion and use of larger chest tubes were not found to have any substantial advantages. Talc appears to be effective and should be the agent of choice for pleurodesis. Thoracoscopic talc insufflation is associated with fewer recurrences of effusions compared with bedside talc slurry, but this is based on two small studies. Where thoracoscopy is unavailable bedside talc pleurodesis has a high success rate and is the next best option.

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Section: Discussionmentioning

confidence: 89%

The evidence on the effectiveness of management for malignant pleural effusion: a systematic review

Tan

Sedrakyan

Browne

et al. 2006

European Journal of Cardio-Thoracic Surgery

230

119

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“…Complications were not seen, whereas none of the catheters malfunctioned [5]. In a study by Pollak et al, the effectiveness of tunneled PC's in the treatment of malignant pleural effusions was assessed in 28 patients [6]. Dyspnea improved in 94% at 48 h and 91% at 30 days.…”

Section: Discussionmentioning

confidence: 99%

“…A more durable effect can be achieved with pleural sclerosis with talc, tetracycline or bleomycin, although unfavorable chemical conditions of the pleural fluid, such as a pH below 7.3, often indicate a disappointing result. In patients not suitable for pleurodesis, or with recurrent MPE after pleurodesis, chronic intermittent drainage via a subcutaneous tunneled pleural catheter (PC) on an outpatient basis has been shown to relieve dyspnea effectively without serious complications [2][3][4].…”

Section: Introductionmentioning

confidence: 99%

Management of recurrent malignant pleural effusions with a chronic indwelling pleural catheter

et al. 2005

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“…5 Pleuroperitoneal shunts also have fallen out of favor because of their difficult maintenance resulting in high rates of patient noncompliance and occlusion of the shunt. 6 It is not uncommon for a patient to present with a malignant pleural effusion before the diagnosis of cancer. In these patients, video-assisted thoracoscopy (VATS) may be used as both a diagnostic tool and a method to achieve mechanical pleurodesis.…”

Section: Traditional Methods Of Managementmentioning

confidence: 99%

Management of recurrent pleural effusions with a tunneled catheter

Baker

Melander

2010

Heart & Lung

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Treatment of Malignant Pleural Effusions with Tunneled Long-term Drainage Catheters

Cited by 88 publications

References 18 publications

The evidence on the effectiveness of management for malignant pleural effusion: a systematic review

The evidence on the effectiveness of management for malignant pleural effusion: a systematic review

Management of recurrent malignant pleural effusions with a chronic indwelling pleural catheter

Management of recurrent pleural effusions with a tunneled catheter

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