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Inchingolo R, Ielo S, Barone R, Whalen MB, Carriera L, Smargiassi A, Sorino C, Lococo F, Feller-Kopman D. Ultrasound and Intrapleural Enzymatic Therapy for Complicated Pleural Effusion: A Case Series with a Literature Review. J Clin Med 2024; 13:4346. [PMID: 39124612 PMCID: PMC11313334 DOI: 10.3390/jcm13154346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2024] [Revised: 07/18/2024] [Accepted: 07/20/2024] [Indexed: 08/12/2024] Open
Abstract
Pleural effusion is the most common manifestation of pleural disease, and chest ultrasound is crucial for diagnostic workup and post-treatment monitoring. Ultrasound helps distinguish the various types of pleural effusion and enables the detection of typical manifestations of empyema, which presents as a complicated, septated effusion. This may benefit from drainage and the use of intrapleural enzyme therapy or may require more invasive approaches, such as medical or surgical thoracoscopy. The mechanism of action of intrapleural enzymatic therapy (IPET) is the activation of plasminogen to plasmin, which breaks down fibrin clots that form septa or the loculation of effusions and promotes their removal. In addition, IPET has anti-inflammatory properties and can modulate the immune response in the pleural space, resulting in reduced pleural inflammation and improved fluid reabsorption. In this article, we briefly review the literature on the efficacy of IPET and describe a case series in which most practical applications of IPET are demonstrated, i.e., as a curative treatment but also as an alternative, propaedeutic, or subsequent treatment to surgery.
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Affiliation(s)
- Riccardo Inchingolo
- UOC Pneumologia, Dipartimento Neuroscienze, Organi di Senso e Torace, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (R.I.); (A.S.)
| | - Simone Ielo
- Facoltà di Medicina e Chirurgia, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (S.I.); (R.B.); (M.B.W.); (L.C.)
| | - Roberto Barone
- Facoltà di Medicina e Chirurgia, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (S.I.); (R.B.); (M.B.W.); (L.C.)
| | - Matteo Bernard Whalen
- Facoltà di Medicina e Chirurgia, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (S.I.); (R.B.); (M.B.W.); (L.C.)
| | - Lorenzo Carriera
- Facoltà di Medicina e Chirurgia, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (S.I.); (R.B.); (M.B.W.); (L.C.)
| | - Andrea Smargiassi
- UOC Pneumologia, Dipartimento Neuroscienze, Organi di Senso e Torace, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (R.I.); (A.S.)
| | - Claudio Sorino
- Division of Pulmonology, Sant’Anna Hospital of Como, University of Insubria, 21100 Varese, Italy
| | - Filippo Lococo
- Thoracic Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Catholic University of the Sacred Heart, 00168 Rome, Italy;
| | - David Feller-Kopman
- Section of Pulmonary and Critical Care Medicine, Dartmouth Hitchcock Medical Center, Lebanon, NH 03766, USA;
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Petersen JK, Fjaellegaard K, Rasmussen DB, Alstrup G, Høegholm A, Sidhu JS, Bhatnagar R, Clementsen PF, Laursen CB, Bodtger U. Patient-Reported Outcome Measures in Patients with and without Non-Expandable Lung Secondary to Malignant Pleural Effusion-A Single-Centre Observational Study. Diagnostics (Basel) 2024; 14:1176. [PMID: 38893702 PMCID: PMC11171895 DOI: 10.3390/diagnostics14111176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2024] [Revised: 05/31/2024] [Accepted: 05/31/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND Malignant pleural effusion (MPE) affects up to 15% of patients with malignancy, and the prevalence is increasing. Non-expandable lung (NEL) complicates MPE in up to 30% of cases. However, it is not known if patients with malignant pleural effusion and NEL are more symptomatic in activities of daily living compared to patients with MPE with expandable lung. METHODS This was an observational study on consecutively recruited patients with MPE from our pleural clinic. Before thoracentesis, patients completed patient-reported outcomes on cancer symptoms (ESAS), health-related quality of life (5Q-5D-5L), and dyspnoea scores. Following thoracentesis, patients scored dyspnoea relief and symptoms during thoracentesis. Data on focused lung ultrasound and pleural effusion biochemistry were collected. The non-expandable lung diagnosis was made by pleural experts based on radiological and clinical information. RESULTS We recruited 43 patients, including 12 with NEL (28%). The NEL cohort resembled those from previous studies concerning ultrasonography, pleural fluid biochemistry, and fewer cases with high volume thoracentesis. Patients with and without NEL were comparable concerning baseline demography. The 5Q-5D-5L utility scores were 0.836 (0.691-0.906) and 0.806 (0.409-0.866), respectively, for patients with and without NEL. We observed no between-group differences in symptom burden or health-related quality of life. CONCLUSION While the presence of NEL affects the clinical management of recurrent MPE, the presence of NEL seems not to affect patients' overall symptom burden in patients with MPE.
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Affiliation(s)
- Jesper Koefod Petersen
- Respiratory Research Unit PLUZ, Department of Internal and Respiratory Medicine, Zealand University Hospitals, Roskilde and Næstved, 4000 Roskilde, Denmark; (K.F.); (D.B.R.); (G.A.); (A.H.); (J.S.S.); (P.F.C.); (U.B.)
- Institute of Regional Health Research, University of Southern Denmark, 5000 Odense, Denmark
| | - Katrine Fjaellegaard
- Respiratory Research Unit PLUZ, Department of Internal and Respiratory Medicine, Zealand University Hospitals, Roskilde and Næstved, 4000 Roskilde, Denmark; (K.F.); (D.B.R.); (G.A.); (A.H.); (J.S.S.); (P.F.C.); (U.B.)
- Institute of Regional Health Research, University of Southern Denmark, 5000 Odense, Denmark
| | - Daniel Bech Rasmussen
- Respiratory Research Unit PLUZ, Department of Internal and Respiratory Medicine, Zealand University Hospitals, Roskilde and Næstved, 4000 Roskilde, Denmark; (K.F.); (D.B.R.); (G.A.); (A.H.); (J.S.S.); (P.F.C.); (U.B.)
- Institute of Regional Health Research, University of Southern Denmark, 5000 Odense, Denmark
| | - Gitte Alstrup
- Respiratory Research Unit PLUZ, Department of Internal and Respiratory Medicine, Zealand University Hospitals, Roskilde and Næstved, 4000 Roskilde, Denmark; (K.F.); (D.B.R.); (G.A.); (A.H.); (J.S.S.); (P.F.C.); (U.B.)
| | - Asbjørn Høegholm
- Respiratory Research Unit PLUZ, Department of Internal and Respiratory Medicine, Zealand University Hospitals, Roskilde and Næstved, 4000 Roskilde, Denmark; (K.F.); (D.B.R.); (G.A.); (A.H.); (J.S.S.); (P.F.C.); (U.B.)
| | - Jatinder Sing Sidhu
- Respiratory Research Unit PLUZ, Department of Internal and Respiratory Medicine, Zealand University Hospitals, Roskilde and Næstved, 4000 Roskilde, Denmark; (K.F.); (D.B.R.); (G.A.); (A.H.); (J.S.S.); (P.F.C.); (U.B.)
| | - Rahul Bhatnagar
- Department of Respiratory Medicine, Odense University Hospital, 2900 Hellerup, Denmark;
- Academic Respiratory Unit, University of Bristol, Bristol BS8 1TU, UK
- Odense Respiratory Research Unit (ODIN), Department of Clinical Research, University of Southern Denmark, 5000 Odense, Denmark
| | - Paul Frost Clementsen
- Respiratory Research Unit PLUZ, Department of Internal and Respiratory Medicine, Zealand University Hospitals, Roskilde and Næstved, 4000 Roskilde, Denmark; (K.F.); (D.B.R.); (G.A.); (A.H.); (J.S.S.); (P.F.C.); (U.B.)
- Copenhagen Academy for Medical Education and Simulation (CAMES), Rigshospitalet, University of Copenhagen and the Capital Region of Denmark, 2100 Copenhagen, Denmark
| | - Christian B. Laursen
- Department of Respiratory Medicine, Odense University Hospital, 2900 Hellerup, Denmark;
- Odense Respiratory Research Unit (ODIN), Department of Clinical Research, University of Southern Denmark, 5000 Odense, Denmark
| | - Uffe Bodtger
- Respiratory Research Unit PLUZ, Department of Internal and Respiratory Medicine, Zealand University Hospitals, Roskilde and Næstved, 4000 Roskilde, Denmark; (K.F.); (D.B.R.); (G.A.); (A.H.); (J.S.S.); (P.F.C.); (U.B.)
- Institute of Regional Health Research, University of Southern Denmark, 5000 Odense, Denmark
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Martins M, Serino M, Viana-Machado F, Novais-Bastos H. Management and prognosis of malignant pleural effusions managed with indwelling pleural catheters. J Bras Pneumol 2023; 49:e20230225. [PMID: 38055389 PMCID: PMC10760441 DOI: 10.36416/1806-3756/e20230225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/08/2023] Open
Affiliation(s)
- M Martins
- . Departamento de Pneumologia, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - M Serino
- . Departamento de Pneumologia, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - F Viana-Machado
- . Departamento de Pneumologia, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - H Novais-Bastos
- . Departamento de Pneumologia, Centro Hospitalar Universitário de São João, Porto, Portugal
- . Instituto de Investigação e Inovação em Saúde - i3S - Universidade do Porto, Porto, Portugal
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Porcel JM, Cordovilla R, Tazi-Mezalek R, Barrios-Barreto D, Pérez-Pallarés J, Novais E Bastos H, Martínez-Tomás R, Flandes-Aldeyturriaga J, Cases-Viedma E, Recalde B, Botana-Rial M. Efficacy and Safety of Indwelling Catheter for Malignant Pleural Effusions Related to Timing of Cancer Therapy: A Systematic Review. Arch Bronconeumol 2023; 59:566-574. [PMID: 37429748 DOI: 10.1016/j.arbres.2023.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 06/19/2023] [Accepted: 06/19/2023] [Indexed: 07/12/2023]
Abstract
INTRODUCTION To compare the efficacy and safety of indwelling pleural catheters (IPC) in relation with the timing of systemic cancer therapy (SCT) (i.e., before, during, or after SCT) in patients with malignant pleural effusion (MPE). METHODS Systematic review of randomized controlled trials (RCT), quasi-controlled trials, prospective and retrospective cohorts, and case series of over 20 patients, in which the timing of IPC insertion in relation to that of SCT was provided. Medline (via PubMed), Embase, and Cochrane Library were systematically searched from inception to January 2023. The risk of bias was assessed using the Cochrane Risk of Bias (ROB) tool for RCTs and the ROB in non-randomized studies of interventions (ROBINS-I) for non-randomized designs. RESULTS Ten studies (n=2907 patients; 3066 IPCs) were included. Using SCT while the IPC was in situ decreased overall mortality, increased survival time, and improved quality-adjusted survival. Timing of SCT had no effect on the risk of IPC-related infections (2.85% overall), even in immunocompromised patients with moderate or severe neutropenia (relative risk 0.98 [95%CI: 0.93-1.03] for patients treated with the combination of IPC and SCT). The inconsistency of the results or the lack of analysis of all outcome measures in relation to the SCT/IPC timing precluded drawing solid conclusions about time to IPC removal or need of re-interventions. CONCLUSIONS Based on observational evidence, the efficacy and safety of IPC for MPE does not seem to vary depending on the IPC insertion timing (before, during, or after SCT). The data most likely support early IPC insertion.
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Affiliation(s)
- José M Porcel
- Pleural Medicine Unit, Hospital Universitario Arnau de Vilanova, IRBLleida, Lleida, Spain.
| | | | | | | | | | - Helder Novais E Bastos
- Centro Hospitalar Universitário de São João, Porto, Portugal; Instituto de Investigação e Inovação em Saúde (i3S), Universidade do Porto, Portugal; Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | | | | | | | | | - Maribel Botana-Rial
- Pulmonary Department, Hospital Álvaro Cunqueiro, EOXI Vigo, Pneumovigo I+I Research Group, Health Research Institute Galicia Sur (IIS Galicia Sur), Vigo, Spain
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