Home-management of malignant pleural effusion with an indwelling pleural catheter: Ten years experience
Introduction
Malignant pleural effusion (MPE) is a well-known sign of end-stage cancer and reduced expectancy of life (median range: 3–12 months).1 Moreover, MPE seriously affects the quality of end-of-life of cancer patients. Therefore, several methods have been proposed to relieve dyspnea. Repetitive thoracentesis is the most widely used method; however, its effect is of short duration.2 Pleurodesis with talc slurry via chest tube or talc insufflation by single port thoracoscopy are both effective.3, 4 However, if the lung remains trapped after fluid evacuation or there is >300 ml/day fluid drainage after chest tube insertion, talc pleurodesis fails.5 In patients not suitable for pleurodesis (low performance status or comorbidity), or with recurrent MPE after pleurodesis, or with trapped lung, the outpatient intermittent drainage through a subcutaneous tunneled indwelling pleural catheter (IPC) relieved dyspnea effectively without complications.6 This study was carried out to investigate the effectiveness of IPC for the outpatient treatment of MPE in these subgroups of patients with MPE. We retrospectively reviewed the results of prospectively collected data on patients who underwent IPC placement.
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Patients and methods
From January 2001 to December 2011, 90 consecutive patients were referred to us for IPC (PleurX; Denver Biomaterials, Golden, Co., USA) (Fig. 1). Implantation for an MPE considered unsuitable for talc pleurodesis or for recurrent MPE after pleurodesis or for a trapped lung. Patients' characteristics are described in Table 1. Unilateral implantation was performed in 83 patients, simultaneous bilateral in 2 patients, and sequentially bilateral in 5 patients. There were 58 male and 32 female
Results
All patients considered the catheter effective and reported a reduction in the grade of dyspnea and improvement of well-being. All patients were discharged home the day of implantation. Minor complications occurred in 10/90 (11.1%) patients. Early complications were observed in 7 patients (7.7%): in two patients subcutaneous emphysema occurred and five experienced pain during evacuation. Local infection was seen in two patients (2.2%); none of them needed hospitalization or to remove the IPC.
Discussion
Talc slurry instillation via chest tube or thoracoscopic insufflation of talc is the method of choice to achieve pleurodesis, with over 90% success rates, provided that the lung can expand.7 Sterile asbestos free talc is readily available and inexpensive, but other agents such as doxycycline are preferred in the United States due to concerns about talc-associated ARDS. The IPC is an effective method for controlling recurrent and symptomatic MPE patients. The presence of foreign material within
Conflict of interest statement
All authors not disclose any financial and personal relationships with other people or organizations that could inappropriately influence (bias) their work.
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Cited by (21)
Quality of life in patients with malignant pleural effusion treated with an indwelling pleural catheter in an emerging country
2022, ClinicsCitation Excerpt :SP was observed in 45% of patients whose catheter was withdrawn, which is consistent with the work of Tremblay et al., with a rate of 43.9% in a total of 250 patients [12]. Since the introduction of IPC in the management of MPE, international studies in developed countries have reported its safety and efficacy [18–20]. Nonetheless, to our knowledge, this is the largest study performed in a developing country to evaluate symptom control, QoL, and feasibility of IPC placement.
Indwelling Pleural Catheters
2021, Encyclopedia of Respiratory Medicine, Second EditionAmbulatory Fibrinolysis in the Management of Septated Malignant Effusions
2019, Archivos de BronconeumologiaOptimizing the study of tunneled intrapleural catheters for malignant pleural effusions
2018, Journal of Thoracic and Cardiovascular SurgeryIndwelling Pleural Catheters: A Clinical Option in Trapped Lung
2017, Thoracic Surgery ClinicsCitation Excerpt :In patients with trapped lungs, IPC remains one of the unique options for palliation of dyspnea related to recurrent MPE. VATS or pleuroscopy requires hospitalization with a median hospital length of stay of 4 to 5 days, whereas IPC is often inserted as 1-day surgical procedure.19 In a nonrandomized trial, patients treated with IPC spent significantly fewer days in the hospital (for any causes) from procedure to death than from pleurodesis and these benefits influence the treatment choice in MPE.18