Use of Indwelling Tunneled Pleural Catheters for the Management of Hepatic Hydrothorax

Kilburn, Jeremy; Hutchings, Jennifer K.; Misselhorn, Dave; Chen, Alexander C.

doi:10.1378/chest.10580

Cited by 17 publications

(7 citation statements)

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“…Specifically for HH, there is concern that infective complications could delay or exclude potential eligible patients from liver transplantation (27). This concern has been amplified by high rates of infection in IPC in series of non-randomised, and predominately retrospective studies of cirrhotic patients, which demonstrate rates between 10 and 25% (28)(29)(30)(31). Reassuringly, in our study there was only one case of IPC related infection and none in HH cohort.…”

Section: Discussionmentioning

confidence: 58%

Randomised trial of indwelling pleural catheters for refractory transudative pleural effusions

et al. 2021

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ObjectiveRefractory symptomatic transudative pleural effusions are an indication for pleural drainage. There has been supportive observational evidence for the use of indwelling pleural catheters (IPCs) for transudative effusions, but no randomised trials. We aimed to investigate the effect of IPCs on breathlessness in patients with transudative pleural effusions when compared with standard care.MethodsA multicentre randomised controlled trial, in which patients with transudative pleural effusions were randomly assigned to either an IPC (intervention) or therapeutic thoracentesis (TT; standard care). The primary outcome was mean daily breathlessness score over 12 weeks from randomisation.Results220 patients were screened from April 2015 to August 2019 across 13 centres, with 33 randomised to intervention (IPC) and 35 to standard care (TT). Underlying aetiology was heart failure in 46 patients, liver failure in 16 and renal failure in six. In primary outcome analysis, the mean±sd breathlessness score over the 12-week study period was 39.7±29.4 mm in the IPC group and 45.0±26.1 mm in the TT group (p=0.67). Secondary outcomes analysis demonstrated that mean±sd drainage was 17 412±17 936 mL and 2901±2416 mL in the IPC and TT groups, respectively. A greater proportion of patients had at least one adverse event in the IPC group (p=0.04).ConclusionWe found no significant difference in breathlessness over 12 weeks between IPCs or TT. TT is associated with fewer complications and IPCs reduced the number of invasive pleural procedures required. Patient preference and circumstances should be considered in selecting the intervention in this cohort.

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Section: Discussionmentioning

confidence: 58%

Randomised trial of indwelling pleural catheters for refractory transudative pleural effusions

et al. 2021

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“…In our patient, we did not perform any systematic pleural fluid culture as we did not observe any sign of infection; on the other hand, an oral protein supplementation with liver-adapted solution was provided, as a mild drop in albumin level was observed. While the success rate of chemical pleurodesis in this context remains low,7 spontaneous pleurodesis after TPC placement has been frequently described in case series 4 8. Interestingly, patients with non-malignant pleural effusion seem to have significantly higher time to pleurodesis compared with malignant aetiology (110.8+41 days vs 36+12 days), and patients with HH have shorter time to spontaneous pleurodesis compared to congestive heart failure.…”

Section: Discussionmentioning

confidence: 99%

Bilateral indwelling pleural catheter for hepatic hydrothorax

2017

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A 68-year-old man with alcoholic liver cirrhosis and portal hypertension was admitted due to ascites. Bilateral severe hepatic hydrothorax did not resolve despite sodium restriction, and diuretic treatment, requiring repeated thoracentesis for relief of dyspnoea. Curative options, as transjugular intrahepatic portosystemic shunt and liver transplantation were both contraindicated. An attempt of pleurodesis was ineffective. Bilateral insertion of tunnelled pleural catheter allowed symptom control and home discharge. After 6 months, bilateral stable pleurodesis has been achieved and patient is still free from dyspnoea.

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“…Patients with hepatic hydrothoraces have been the focus of calls for increased research [72] because this population often has a limited range of therapeutic options available to them, as well as having a tendency to suffer from large compromising effusions. Small-scale studies are beginning to allay fears of excess infection rates and the loss of protein or electrolytes, although mortality from the underlying liver condition remains extremely high [37,71,73].…”

Section: Use Of Ipcs In Non-malignant Diseasementioning

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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Use of Indwelling Tunneled Pleural Catheters for the Management of Hepatic Hydrothorax

Cited by 17 publications

References 0 publications

Randomised trial of indwelling pleural catheters for refractory transudative pleural effusions

Randomised trial of indwelling pleural catheters for refractory transudative pleural effusions

Bilateral indwelling pleural catheter for hepatic hydrothorax

Indwelling Pleural Catheters

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