1
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Sidhu C, Davies HE, Muruganandan S, Lui MMS, Lau EPM, Lee YCG. Indwelling Pleural Catheter: Management of Complications. Semin Respir Crit Care Med 2023. [PMID: 37257836 DOI: 10.1055/s-0043-1769093] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Multiple randomized clinical trials have established the advantages of indwelling pleural catheter (IPC) in the management of malignant pleural effusions, resulting in its widespread adoption in clinical practice. Complications can occur with IPC use and must be recognized and managed effectively. This review provides a comprehensive overview of IPC complications and their best care. Pain postinsertion or during drainage of IPC is easily manageable and must be distinguished from tumor-related chest wall pain. IPC-related infections require systemic antibiotics and often intrapleural fibrinolytic/deoxyribonuclease therapy. The removal of IPC for infection is usually unnecessary. Symptomatic loculation usually responds to fibrinolytics but may recur. Catheter tract metastases are common in mesothelioma patients and usually respond to radiotherapy without inducing damages to the IPC. Less common complications include dislodgement, irreversible blockage, and fractures (upon removal) of the catheter. Recommendations on the management of IPC complications by recent consensus statement/guideline are discussed. Expert opinions on management approaches are included in areas where evidence is lacking to guide care.
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Affiliation(s)
- Calvin Sidhu
- Pleural Medicine Unit, Institute for Respiratory Health, Perth, Australia
- School of Medical and Health Sciences, Edith Cowan University, Perth, Australia
- Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, Australia
| | - Helen E Davies
- Department of Respiratory Medicine, University Hospital of Wales, Cardiff, United Kingdom
| | - Sanjeevan Muruganandan
- Department of Respiratory Medicine, Northern Health, Melbourne, Australia
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Victoria, Australia
| | - Macy M S Lui
- Division of Respiratory Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong
| | - Estee P M Lau
- Pleural Medicine Unit, Institute for Respiratory Health, Perth, Australia
- School of Medical and Health Sciences, Edith Cowan University, Perth, Australia
| | - Y C Gary Lee
- Pleural Medicine Unit, Institute for Respiratory Health, Perth, Australia
- Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, Australia
- School of Medicine, University of Western Australia, Perth, Australia
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2
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Trovisco R, Freitas C, Serino M, Ferreira P, Martins B, Coelho D, Melo N, Fernandes G, Magalhães A, Bastos HN. Predictors of lung entrapment in malignant pleural effusion. Pulmonology 2022:S2531-0437(22)00199-4. [PMID: 36180353 DOI: 10.1016/j.pulmoe.2022.08.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 07/25/2022] [Accepted: 08/03/2022] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Malignant pleural effusion (MPE) is a common complication in advanced stages of malignancy and is associated with poor prognosis. Non-expandable lung (NEL) often occurs and its presence influences the MPE approach. Our main objective was to assess risk factors for malignant NEL. METHODS Patients diagnosed with pathologically confirmed MPE between January 2012 and December 2018 in our institution were retrospectively analyzed. Demographic and clinical data of patients were reviewed and compared according to the presence or absence of NEL. A univariate and multivariate binary logistic regression analysis were used to determine predictors of the development of NEL. RESULTS Of 365 patients included, 68 (18.6%) had NEL. After multivariate analysis, we found that loculated MPE (OR 8.63, 95%CI 4.30-17.33, p<0.001), complete hemithorax opacification (OR 2.81, 95%CI 1.17-6.76, p<0.021), lung cancer (OR 2.09, 95%CI 1.01-4.31, p=0.047) and higher effusion-serum LDH ratio (OR 1.09, 95%CI 1.00-1.17, p=0.039) were independent predictors of malignant NEL. There were no significant differences compared with expandable lung group regarding time from primary malignancy diagnosis to MPE diagnosis (3.0, IQR 0.0-75.8 vs 2.0, IQR 0.0-75.5 weeks, p=0.942) or MPE symptoms onset to MPE diagnosis (4.0, IQR 1.0-9.0 vs 3.0, IQR 1.0-9.0 weeks, p=0.497). Patients with NEL had a higher number of therapeutic pleural drainages (3.0, IQR 2.0-6.0 vs 2.0, IQR 1.0-3.0; p<0.001) and longer hospital stay (32.5, IQR 15.5-46.3 vs 21.0, IQR 11.0-36.0, p=0.007), measured in hospitalization days until the end of life, than patients with expandable lung. The rate of recurrence of pleural effusion was not significantly different between groups (p=0.291). Overall survival (OS) was 3.0 (95%CI, 2.3-3.7) months, regardless of lung expandability (p=0.923). CONCLUSION Loculated MPE, complete hemithorax opacification, lung cancer and a higher effusion-serum LDH ratio were found to be independent predictors for NEL. These patients underwent thoracocenteses more frequently and had longer hospitalization days, although without significant impact in the OS.
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Affiliation(s)
- R Trovisco
- Faculty of Medicine, University of Porto, Alameda Prof. Hernani Monteiro, 4200-319 Porto, Portugal
| | - C Freitas
- Faculty of Medicine, University of Porto, Alameda Prof. Hernani Monteiro, 4200-319 Porto, Portugal; Department of Pulmonology, Centro Hospitalar e Universitário São João, Porto, Portugal
| | - M Serino
- Department of Pulmonology, Centro Hospitalar e Universitário São João, Porto, Portugal
| | - P Ferreira
- Department of Pulmonology, Centro Hospitalar e Universitário São João, Porto, Portugal
| | - B Martins
- Department of Pulmonology, Centro Hospitalar e Universitário São João, Porto, Portugal
| | - D Coelho
- Faculty of Medicine, University of Porto, Alameda Prof. Hernani Monteiro, 4200-319 Porto, Portugal; Department of Pulmonology, Centro Hospitalar e Universitário São João, Porto, Portugal
| | - N Melo
- Department of Pulmonology, Centro Hospitalar e Universitário São João, Porto, Portugal
| | - G Fernandes
- Faculty of Medicine, University of Porto, Alameda Prof. Hernani Monteiro, 4200-319 Porto, Portugal; Department of Pulmonology, Centro Hospitalar e Universitário São João, Porto, Portugal
| | - A Magalhães
- Department of Pulmonology, Centro Hospitalar e Universitário São João, Porto, Portugal
| | - H N Bastos
- Faculty of Medicine, University of Porto, Alameda Prof. Hernani Monteiro, 4200-319 Porto, Portugal; Department of Pulmonology, Centro Hospitalar e Universitário São João, Porto, Portugal; Institute for Research and Innovation in Health, University of Porto, Rua Alfredo Allen, 208, 4200-136 Porto, Portugal.
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3
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Abana O, Ghori U, Alqaid A, Holladay R. The Malpositioned Tunneled Pleural Catheter: Rare Images From Interventional Pulmonology. J Bronchology Interv Pulmonol 2021; 28:e62-e65. [PMID: 34546195 DOI: 10.1097/lbr.0000000000000750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
| | - Uzair Ghori
- Department of Pulmonary and Critical Care Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Ammar Alqaid
- Pulmonary and Critical Care Medicine LSU Health, Shreveport, LA
| | - Robert Holladay
- Pulmonary and Critical Care Medicine LSU Health, Shreveport, LA
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4
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Fukaya T, Kasai H, Saito M, Sasatani Y, Urushibara T, Sakao S. Yellow nail syndrome with massive chylothorax after esophagectomy: A case report. Respir Med Case Rep 2021; 33:101448. [PMID: 34401287 PMCID: PMC8349037 DOI: 10.1016/j.rmcr.2021.101448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 05/22/2021] [Accepted: 05/29/2021] [Indexed: 11/16/2022] Open
Abstract
Yellow nail syndrome (YNS) is a rare condition characterized by the triad of yellow nails, lymphedema, and respiratory manifestations. Diuretics and thoracic drainage are often not effective in YNS, and the most effective treatments are pleurodesis and decortication/pleurectomy. A 66-year-old man was admitted to our hospital for YNS after esophagectomy with gastric tube reconstruction for esophageal cancer. The patient presented with yellow nails and lymphedema. Chest X-rays and computed tomography showed massive pleural effusions and ascites that were both chylous. The patient was considered to have YNS that became apparent after surgery. He recovered with diuretics and a low-fat diet without pleurodesis and decortication/pleurectomy. Thoracic surgery can exacerbate the functional impairment of lymphatic drainage in patients with asymptomatic and undiagnosed YNS, and can lead to further development of YNS-related clinical symptoms. Despite relatively massive chylothorax following thoracic surgery, chylothorax related to YNS could be successfully controlled with conservative treatment without pleurodesis and decortication/pleurectomy.
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Affiliation(s)
- Takumi Fukaya
- Department of Medicine, School of Medicine, Chiba University, Chiba, 260-8670, Japan
| | - Hajime Kasai
- Department of Respiratory Medicine, Kimitsu Chuo Hospital, Kisarazu, 292-8535, Japan.,Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, 260-8670, Japan
| | - Mikihito Saito
- Department of Respiratory Medicine, Kimitsu Chuo Hospital, Kisarazu, 292-8535, Japan
| | - Yuika Sasatani
- Department of Respiratory Medicine, Kimitsu Chuo Hospital, Kisarazu, 292-8535, Japan.,Department of Respiratory Medicine, Mito Medical Center, Mito, 310-0015, Japan
| | - Takashi Urushibara
- Department of Respiratory Medicine, Kimitsu Chuo Hospital, Kisarazu, 292-8535, Japan
| | - Seiichiro Sakao
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, 260-8670, Japan
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5
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Pleurodesis: From Thoracic Surgery to Interventional Pulmonology. Respir Med 2021. [DOI: 10.1007/978-3-030-80298-1_15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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6
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Botana-Rial M, Ramos-Hernández C, Lojo-Rodríguez I, Represas-Represas C, Ruano-Raviña A, Leiro-Fernández V, Fernández-Villar A. Cost Effectiveness of Malignant Pleural Effusion with Indwelling Catheter: Systematic Review. J Palliat Med 2020; 24:1206-1212. [PMID: 33395352 DOI: 10.1089/jpm.2020.0695] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: The current cost of treatment of malignant pleural effusion (MPE) with an indwelling pleural catheter (IPC) is unclear. Objective: We propose a review of the scientific evidence on the cost and effectiveness of this therapeutic option. Methods: Systematic review of the literature on the cost and effectiveness of the treatment of MPE by IPC, according to the PRISMA methodology and quality according to the scientific guidelines. Results: A total of 4 articles, 152 patients, and 159 IPCs were included. The use of IPC was associated with improvement in symptoms and quality of life. The most common complications were infections (empyema in 20.9% of patients and cellulitis in 17.3%); 9% of cases were hospitalized due to complications, and <2% required subsequent procedures. The average cost of IPC (set/drainage bottles) ranged from €2,025.6 to €1,200.5 if it was placed on an outpatient basis, €1,100 if survival was <6 weeks, and €4,028 in patients with mesothelioma. Complications increased the cost, and taking into account follow-up visits, additional tests, and days of admission for complications, the cost was >€5,000. Compared with pleurodesis, the cost of IPC was significantly lower when patient survival was <14 weeks, but not when survival was longer or home care was required. Conclusions: The use of IPC is associated with good control of MPE and seldom requires many subsequent procedures; however, it is also associated with a certain rate of complications, which may increase costs. However, ambulatory management may help reduce costs, which are directly related to the type of tumor, the duration of survival, and the need for specialized treatment.
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Affiliation(s)
- Maribel Botana-Rial
- Pulmonary Department, Hospital Álvaro Cunqueiro, Vigo, Spain.,PneumoVigoI+I Research Group, Sanitary Research Institute Galicia Sur (IIS Galicia Sur), Vigo, Spain
| | - Cristina Ramos-Hernández
- Pulmonary Department, Hospital Álvaro Cunqueiro, Vigo, Spain.,PneumoVigoI+I Research Group, Sanitary Research Institute Galicia Sur (IIS Galicia Sur), Vigo, Spain
| | - Irene Lojo-Rodríguez
- Pulmonary Department, Hospital Álvaro Cunqueiro, Vigo, Spain.,PneumoVigoI+I Research Group, Sanitary Research Institute Galicia Sur (IIS Galicia Sur), Vigo, Spain
| | - Cristina Represas-Represas
- Pulmonary Department, Hospital Álvaro Cunqueiro, Vigo, Spain.,PneumoVigoI+I Research Group, Sanitary Research Institute Galicia Sur (IIS Galicia Sur), Vigo, Spain
| | - Alberto Ruano-Raviña
- Deparment of Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago de Compostela, Spain.,Consortium for Biomedical Research in Epidemiologic and Public Health (CIBER en Epidemiologia y Salúd Pública-CIBERESP), Madrid, Spain
| | - Virginia Leiro-Fernández
- Pulmonary Department, Hospital Álvaro Cunqueiro, Vigo, Spain.,PneumoVigoI+I Research Group, Sanitary Research Institute Galicia Sur (IIS Galicia Sur), Vigo, Spain
| | - Alberto Fernández-Villar
- Pulmonary Department, Hospital Álvaro Cunqueiro, Vigo, Spain.,PneumoVigoI+I Research Group, Sanitary Research Institute Galicia Sur (IIS Galicia Sur), Vigo, Spain
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7
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Bhatnagar M, Slight R, Prasad AB, Stanton AE. Prolonged air leak after IPC insertion: An unusual complication. Respir Med Case Rep 2020; 31:101257. [PMID: 33101900 PMCID: PMC7578547 DOI: 10.1016/j.rmcr.2020.101257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 10/10/2020] [Accepted: 10/11/2020] [Indexed: 11/29/2022] Open
Abstract
Indwelling pleural catheters [IPC] have an important role in the management of malignant pleural effusions. We report the development of a significant air leak following IPC insertion with resultant extensive subcutaneous emphysema. The air leak developed, presumably, as a result of visceral pleural disruption, which occurred at the time of vacuum drainage of pleural fluid after IPC placement and not due to lung injury during insertion. The patient required insertion of a large bore intercostal drain connected to low-pressure negative suction. He was eventually discharged home with the aid of an ambulatory system. Although commonly seen in the surgical setting, we believe emergency and respiratory physicians should be aware of the risk of such a complication, and the challenges in its management.
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Affiliation(s)
- Malvika Bhatnagar
- Department of Respiratory Medicine, Freeman Hospital, Newcastle Upon Tyne Hospitals NHS Trust, Freeman Road, High Heaton, Newcastle Upon Tyne, NE7 7DN, United Kingdom
| | - Robert Slight
- Department of Cardiothoracic Surgery, Freeman Hospital, Newcastle Upon Tyne Hospitals NHS Trust, Freeman Road, High Heaton, Newcastle Upon Tyne, NE7 7DN, United Kingdom.,Newcastle University, Newcastle Upon Tyne, NE1 7RU, United Kingdom
| | - Arun Brahmanya Prasad
- Department of Respiratory Medicine, Freeman Hospital, Newcastle Upon Tyne Hospitals NHS Trust, Freeman Road, High Heaton, Newcastle Upon Tyne, NE7 7DN, United Kingdom.,Department of Respiratory Medicine, Royal Victoria Infirmary, Newcastle Upon Tyne Hospitals NHS Trust, Queen Victoria Road, Newcastle Upon Tyne, NE1 4LP, United Kingdom
| | - Andrew Ewing Stanton
- Department of Respiratory Medicine, Freeman Hospital, Newcastle Upon Tyne Hospitals NHS Trust, Freeman Road, High Heaton, Newcastle Upon Tyne, NE7 7DN, United Kingdom
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8
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Jacob S, Ali M, El-Sayed Ahmed MM, Itkin M, Narula T, Pham S, Erasmus D. Refractory chylous effusions in lymphangioleiomyomatosis patient post lung transplant. SAGE Open Med Case Rep 2020; 8:2050313X20921332. [PMID: 32477564 PMCID: PMC7233883 DOI: 10.1177/2050313x20921332] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Accepted: 04/01/2020] [Indexed: 11/17/2022] Open
Abstract
Lymphangioleiomyomatosis is a rare systemic disorder of unknown etiology that affects young women almost exclusively. Chylous effusions are known to be associated with lymphangioleiomyomatosis and may be difficult to treat. We present the case of a 37-year-old female who received bilateral lung transplantation for lymphangioleiomyomatosis complicated by refractory chylothorax and chylous ascites, ultimately controlled through repeated, open surgical procedures and percutaneous lymphatic embolization interventions. The combined surgical and interventional radiological approach, while not novel in their own right, suggests that a multi-modal interventional approach may be required in refractory cases.
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Affiliation(s)
- Samuel Jacob
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Mojahid Ali
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, FL, USA
| | | | - Maxim Itkin
- Center for Lymphatic Disorders, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Tathagat Narula
- Department of Transplantation, Mayo Clinic, Jacksonville, FL, USA
| | - Si Pham
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - David Erasmus
- Department of Transplantation, Mayo Clinic, Jacksonville, FL, USA
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9
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Bhatnagar R, Piotrowska HEG, Laskawiec-Szkonter M, Kahan BC, Luengo-Fernandez R, Pepperell JCT, Evison MD, Holme J, Al-Aloul M, Psallidas I, Lim WS, Blyth KG, Roberts ME, Cox G, Downer NJ, Herre J, Sivasothy P, Menzies D, Munavvar M, Kyi MM, Ahmed L, West AG, Harrison RN, Prudon B, Hettiarachchi G, Chakrabarti B, Kavidasan A, Sutton BP, Zahan-Evans NJ, Quaddy JL, Edey AJ, Clive AO, Walker SP, Little MHR, Mei XW, Harvey JE, Hooper CE, Davies HE, Slade M, Sivier M, Miller RF, Rahman NM, Maskell NA. Effect of Thoracoscopic Talc Poudrage vs Talc Slurry via Chest Tube on Pleurodesis Failure Rate Among Patients With Malignant Pleural Effusions: A Randomized Clinical Trial. JAMA 2020; 323:60-69. [PMID: 31804680 PMCID: PMC6990658 DOI: 10.1001/jama.2019.19997] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
IMPORTANCE Malignant pleural effusion (MPE) is challenging to manage. Talc pleurodesis is a common and effective treatment. There are no reliable data, however, regarding the optimal method for talc delivery, leading to differences in practice and recommendations. OBJECTIVE To test the hypothesis that administration of talc poudrage during thoracoscopy with local anesthesia is more effective than talc slurry delivered via chest tube in successfully inducing pleurodesis. DESIGN, SETTING, AND PARTICIPANTS Open-label, randomized clinical trial conducted at 17 UK hospitals. A total of 330 participants were enrolled from August 2012 to April 2018 and followed up until October 2018. Patients were eligible if they were older than 18 years, had a confirmed diagnosis of MPE, and could undergo thoracoscopy with local anesthesia. Patients were excluded if they required a thoracoscopy for diagnostic purposes or had evidence of nonexpandable lung. INTERVENTIONS Patients randomized to the talc poudrage group (n = 166) received 4 g of talc poudrage during thoracoscopy while under moderate sedation, while patients randomized to the control group (n = 164) underwent bedside chest tube insertion with local anesthesia followed by administration of 4 g of sterile talc slurry. MAIN OUTCOMES AND MEASURES The primary outcome was pleurodesis failure up to 90 days after randomization. Secondary outcomes included pleurodesis failure at 30 and 180 days; time to pleurodesis failure; number of nights spent in the hospital over 90 days; patient-reported thoracic pain and dyspnea at 7, 30, 90, and 180 days; health-related quality of life at 30, 90, and 180 days; all-cause mortality; and percentage of opacification on chest radiograph at drain removal and at 30, 90, and 180 days. RESULTS Among 330 patients who were randomized (mean age, 68 years; 181 [55%] women), 320 (97%) were included in the primary outcome analysis. At 90 days, the pleurodesis failure rate was 36 of 161 patients (22%) in the talc poudrage group and 38 of 159 (24%) in the talc slurry group (adjusted odds ratio, 0.91 [95% CI, 0.54-1.55]; P = .74; difference, -1.8% [95% CI, -10.7% to 7.2%]). No statistically significant differences were noted in any of the 24 prespecified secondary outcomes. CONCLUSIONS AND RELEVANCE Among patients with malignant pleural effusion, thoracoscopic talc poudrage, compared with talc slurry delivered via chest tube, resulted in no significant difference in the rate of pleurodesis failure at 90 days. However, the study may have been underpowered to detect small but potentially important differences. TRIAL REGISTRATION ISRCTN Identifier: ISRCTN47845793.
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Affiliation(s)
- Rahul Bhatnagar
- Academic Respiratory Unit, University of Bristol, Bristol, United Kingdom
- North Bristol Lung Centre, North Bristol NHS Trust, Bristol, United Kingdom
| | - Hania E. G. Piotrowska
- Oxford Respiratory Trials Unit, Nuffield Department of Experimental Medicine, University of Oxford, United Kingdom
| | - Magda Laskawiec-Szkonter
- Oxford Respiratory Trials Unit, Nuffield Department of Experimental Medicine, University of Oxford, United Kingdom
| | - Brennan C. Kahan
- Pragmatic Clinical Trials Unit, Queen Mary University of London, London, United Kingdom
| | - Ramon Luengo-Fernandez
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, United Kingdom
| | - Justin C. T. Pepperell
- Somerset Lung Centre, Musgrove Park Hospital, Taunton and Somerset NHS Foundation Trust, Taunton, United Kingdom
| | - Matthew D. Evison
- North West Lung Centre, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Jayne Holme
- North West Lung Centre, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Mohamed Al-Aloul
- North West Lung Centre, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Ioannis Psallidas
- Lungs for Living Research Centre, University College London, London, United Kingdom
| | - Wei Shen Lim
- Respiratory Medicine, Nottingham University Hospitals NHS Trust, United Kingdom
- University of Nottingham, United Kingdom
| | - Kevin G. Blyth
- Glasgow Pleural Disease Unit, Queen Elizabeth University Hospital, Glasgow, United Kingdom
- Institute of Infection, Immunity & Inflammation, University of Glasgow, Glasgow, United Kingdom
| | - Mark E. Roberts
- Respiratory Department, Sherwood Forest Hospitals Trust, United Kingdom
| | - Giles Cox
- Respiratory Department, Sherwood Forest Hospitals Trust, United Kingdom
| | - Nicola J. Downer
- Respiratory Department, Sherwood Forest Hospitals Trust, United Kingdom
| | - Jurgen Herre
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Pasupathy Sivasothy
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | | | - Mohammed Munavvar
- Lancashire Teaching Hospitals NHS, Foundation Trust, Preston, United Kingdom
| | - Moe M. Kyi
- Respiratory Department, Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust, Doncaster, United Kingdom
| | - Liju Ahmed
- Respiratory Department, Guy's and St Thomas' NHS Trust, London, United Kingdom
| | - Alex G. West
- Respiratory Department, Guy's and St Thomas' NHS Trust, London, United Kingdom
| | - Richard N. Harrison
- Respiratory Medicine, North Tees and Hartlepool NHS Foundation Trust, Stockton-on-Tees, United Kingdom
| | - Benjamin Prudon
- Respiratory Medicine, North Tees and Hartlepool NHS Foundation Trust, Stockton-on-Tees, United Kingdom
| | | | | | - Ajikumar Kavidasan
- Milton Keynes University Hospital, Milton Keynes, United Kingdom
- Croydon University Hospital, Croydon, United Kingdom
| | - Benjamin P. Sutton
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Natalie J. Zahan-Evans
- Academic Respiratory Unit, University of Bristol, Bristol, United Kingdom
- North Bristol Lung Centre, North Bristol NHS Trust, Bristol, United Kingdom
| | - Jack L. Quaddy
- Oxford Respiratory Trials Unit, Nuffield Department of Experimental Medicine, University of Oxford, United Kingdom
| | - Anthony J. Edey
- North Bristol Lung Centre, North Bristol NHS Trust, Bristol, United Kingdom
| | - Amelia O. Clive
- Academic Respiratory Unit, University of Bristol, Bristol, United Kingdom
- North Bristol Lung Centre, North Bristol NHS Trust, Bristol, United Kingdom
| | - Steven P. Walker
- Academic Respiratory Unit, University of Bristol, Bristol, United Kingdom
- North Bristol Lung Centre, North Bristol NHS Trust, Bristol, United Kingdom
| | - Matthew H. R. Little
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, United Kingdom
| | - Xue W. Mei
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, United Kingdom
| | - John E. Harvey
- North Bristol Lung Centre, North Bristol NHS Trust, Bristol, United Kingdom
| | - Clare E. Hooper
- Worcester Acute Hospitals NHS Trust, Worcester, United Kingdom
| | - Helen E. Davies
- Cardiff and Vale University Health Board, Wales, United Kingdom
| | - Mark Slade
- Department of Respiratory Medicine, Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, United Kingdom
| | | | - Robert F. Miller
- Institute for Global Health, University College London, London, United Kingdom
| | - Najib M. Rahman
- Oxford Respiratory Trials Unit, Nuffield Department of Experimental Medicine, University of Oxford, United Kingdom
| | - Nick A. Maskell
- Academic Respiratory Unit, University of Bristol, Bristol, United Kingdom
- North Bristol Lung Centre, North Bristol NHS Trust, Bristol, United Kingdom
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10
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Tamburrini M, Desai U, Zuccon U. Novel complications of the tunnelled indwelling pleural catheter. Pulmonology 2019; 26:166-168. [PMID: 31757609 DOI: 10.1016/j.pulmoe.2019.08.008] [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: 06/02/2019] [Revised: 07/24/2019] [Accepted: 08/21/2019] [Indexed: 11/27/2022] Open
Abstract
Tunnelled indwelling pleural catheters (TIPC) are a modality of treatment for malignant pleural effusions. Though relatively easy, safe and efficacious, they are associated with a small risk of complications. We describe newer complications of the TIPC including the retention of the polyester plug and the blockage of the catheter with thick organised material consisting of malignant cells taking the shape of the catheter.
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Affiliation(s)
- M Tamburrini
- UOC Pneumologia, AAS5 Friuli Occidentale, Pordenone, Italy.
| | - U Desai
- Associate Professor & I/C, Department of Pulmonary Medicine, TNMC & BYL Nair Hospital, Mumbai, India
| | - U Zuccon
- UOC Pneumologia, AAS5 Friuli Occidentale, Pordenone, Italy
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11
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Pospiskova J, Smolej L, Belada D, Simkovic M, Motyckova M, Sykorova A, Stepankova P, Zak P. Experiences in the treatment of refractory chylothorax associated with lymphoproliferative disorders. Orphanet J Rare Dis 2019; 14:9. [PMID: 30626415 PMCID: PMC6327395 DOI: 10.1186/s13023-018-0991-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 12/28/2018] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Chylothorax is a rare condition which can be associated with malignant lymphoproliferative disorders (LPDs). We retrospectively analyzed the results of the conservative treatment of 10 patients with persistent non-traumatic malignant chylothorax. RESULTS Conservative treatment lead to a decline of chylothorax after mean of 66 days and consisted of the treatment of the underlying disease and of simultaneous long-term supportive care (drainage of the thoracic cavity, dietary measures and nutrition management). In most cases (80%), chylothorax disappeared only after a successful therapeutic response of the underlying disease. Low-dose radiotherapy had very good effects in two patients. CONCLUSION Conservative treatment of malignant chylothorax can be considered a suitable method. Based on our results, successful treatment of the lymphoproliferative disorder seems to be a very important factor for the disappearance of chylothorax.
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Affiliation(s)
- Jana Pospiskova
- 4th Department of Internal Medicine - Hematology, University Hospital, Sokolska Street 581, 5005, Hradec Kralove, Czech Republic
| | - Lukas Smolej
- 4th Department of Internal Medicine - Hematology, University Hospital, Sokolska Street 581, 5005, Hradec Kralove, Czech Republic.,Faculty of Medicine in Hradec Králové, Charles University Prague, Hradec Kralove, Czech Republic
| | - David Belada
- 4th Department of Internal Medicine - Hematology, University Hospital, Sokolska Street 581, 5005, Hradec Kralove, Czech Republic.,Faculty of Medicine in Hradec Králové, Charles University Prague, Hradec Kralove, Czech Republic
| | - Martin Simkovic
- 4th Department of Internal Medicine - Hematology, University Hospital, Sokolska Street 581, 5005, Hradec Kralove, Czech Republic.,Faculty of Medicine in Hradec Králové, Charles University Prague, Hradec Kralove, Czech Republic
| | - Monika Motyckova
- 4th Department of Internal Medicine - Hematology, University Hospital, Sokolska Street 581, 5005, Hradec Kralove, Czech Republic.,Faculty of Medicine in Hradec Králové, Charles University Prague, Hradec Kralove, Czech Republic
| | - Alice Sykorova
- 4th Department of Internal Medicine - Hematology, University Hospital, Sokolska Street 581, 5005, Hradec Kralove, Czech Republic
| | - Pavla Stepankova
- 4th Department of Internal Medicine - Hematology, University Hospital, Sokolska Street 581, 5005, Hradec Kralove, Czech Republic
| | - Pavel Zak
- 4th Department of Internal Medicine - Hematology, University Hospital, Sokolska Street 581, 5005, Hradec Kralove, Czech Republic. .,Faculty of Medicine in Hradec Králové, Charles University Prague, Hradec Kralove, Czech Republic.
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12
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Mitchell M, Li P, Pease C, Hosseini S, Souza C, Zhang T, Amjadi K. Catheter Tract Metastasis in Mesothelioma Patients with Indwelling Pleural Catheters: A Retrospective Cohort Study. Respiration 2018; 97:428-435. [DOI: 10.1159/000494500] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 10/12/2018] [Indexed: 11/19/2022] Open
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13
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Ahmed M, Wrightson JM. Malignant Pleural Effusions—Personalised Management. CURRENT GERIATRICS REPORTS 2018. [DOI: 10.1007/s13670-018-0246-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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14
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Ceruti P, Lonni S, Baglivo F, Marchetti G. Endoscopic diagnosis and management of pleural effusion in malignant pleural mesothelioma. J Thorac Dis 2018; 10:S269-S275. [PMID: 29507795 DOI: 10.21037/jtd.2017.09.142] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Malignant pleural mesothelioma (MPM) is an asbestos-related aggressive tumor, that requires proper diagnosis and management. Symptoms are nonspecific and chest computed tomography (CT) and chest ultrasound (US) are important radiological tools in the initial workup to identify early pathological signs. Performing a medical thoracoscopy (MT) is essential for a definitive diagnosis of MPM. The procedure, integrated with a prior US, allows a global evaluation of the pleural cavity and the execution of multiple targeted biopsies, with low risk of complications. Some different endoscopic patterns are recognized. Thoracoscopic biopsies provide enough material to allow a thorough pathological and immunohistochemical characterization. The presence of extensive pleural adhesions and critical patient conditions are the only absolute contraindications. The clinical course of MPM is characterized by chronic symptoms such as chest pain and progressive dyspnea, the latter caused mainly by recurrent pleural effusion. Palliative interventions are required in order to relieve symptoms and improve the quality of life (QoL). These include thoracentesis, pleurodesis and the placement of an indwelling pleural catheter.
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Affiliation(s)
- Paolo Ceruti
- Division of Pulmonology, Cardiothoracic Department, Spedali Civili Hospital, Brescia, Italy
| | - Sara Lonni
- Department of Medical and Surgical Sciences, Specialization School in Respiratory Diseases, Brescia, Italy
| | - Francesca Baglivo
- Department of Medical and Surgical Sciences, Specialization School in Respiratory Diseases, Brescia, Italy
| | - Giampietro Marchetti
- Division of Pulmonology, Cardiothoracic Department, Spedali Civili Hospital, Brescia, Italy
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15
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Garbuzenko DV, Arefyev NO. Hepatic hydrothorax: An update and review of the literature. World J Hepatol 2017; 9:1197-1204. [PMID: 29152039 PMCID: PMC5680207 DOI: 10.4254/wjh.v9.i31.1197] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Revised: 09/17/2017] [Accepted: 10/16/2017] [Indexed: 02/06/2023] Open
Abstract
This review considers the modern concepts of pathogenesis, diagnostic methods, and treatment principles of hepatic hydrothorax (HH). HH is the excessive (> 500 mL) accumulation of transudate in the pleural cavity in patients with decompensated liver cirrhosis but without cardiopulmonary and pleural diseases. It causes respiratory failure which aggravates the clinical course of liver cirrhosis, and the emergence of spontaneous bacterial pleural empyema may be the cause of death. The information was collected from the PubMed database, the Google Scholar retrieval system, the Cochrane reviews, and the reference lists from relevant publications for 1994-2016 using the keywords: “liver cirrhosis”, “portal hypertension”, “hepatic hydrothorax”, “pathogenesis”, “diagnostics”, and “treatment”. To limit the scope of this review, only articles dealing with uncomplicated hydrothorax in patients with liver cirrhosis were included. The analysis of the data showed that despite the progress of modern hepatology, the presence of HH is associated with poor prognosis and high mortality. Most patients suffering from it are candidates for orthotopic liver transplantation. In routine clinical practice, stratification of the risk for an adverse outcome and the subsequent determination of individual therapeutic strategies may be the keys to the successful management of the patient’s condition. The development of pathogenetic pharmacotherapy and optimization of minimally invasive treatment will improve the quality of life and increase the survival rate among patients with HH.
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16
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Tunneled Pleural Catheter Placement with and without Talc Poudrage for Treatment of Pleural Effusions Due to Congestive Heart Failure. Ann Am Thorac Soc 2016; 13:212-6. [PMID: 26598967 DOI: 10.1513/annalsats.201507-471bc] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
RATIONALE There is a paucity of evidence regarding the role of tunneled pleural catheters in pleural effusions caused by congestive heart failure that is refractory to medical management. OBJECTIVES The aim of this study was to assess the feasibility of tunneled pleural catheter drainage for treatment of refractory pleural effusions associated with congestive heart failure, either when used alone or with concomitant talc pleurodesis performed during thoracoscopy. METHODS This was a retrospective cohort study. We identified patients with congestive heart failure and recurrent symptomatic pleural effusions who were treated between 2005 and 2015 by placement of a tunneled pleural catheter. Patients underwent either thoracoscopy followed by talc poudrage and pleural catheter placement (group 1) or catheter insertion alone (group 2). MEASUREMENTS AND MAIN RESULTS Forthy-three catheters were inserted in 36 patients, with 15 placed in group 1 and 28 in group 2. Successful pleurodesis was seen in 80% in group 1 and 25% in group 2. The median time of catheter placement was 11.5 days in group 1 and 66 days in group 2. There was a significant decrease in hospital admissions and pleural interventions after catheter placement compared with before insertion (P < 0.05). CONCLUSIONS This single-center, retrospective study demonstrated the feasibility of catheter placement used alone or with talc poudrage for the treatment of refractory pleural effusions associated with congestive heart failure. The addition of talc poudrage might increase the pleurodesis rate and reduce the days to catheter removal in highly selected patients. Prospective studies on a larger number of patients are warranted to verify the safety and efficacy of this intervention.
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17
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Walker S, Bibby AC, Maskell NA. Current best practice in the evaluation and management of malignant pleural effusions. Ther Adv Respir Dis 2016; 11:105-114. [PMID: 27777372 DOI: 10.1177/1753465816671697] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Malignant pleural effusions (MPEs) are an important cause of cancer-related mortality and morbidity. It is a heterogeneous group of conditions, which leads to debilitating symptoms and confers a poor prognosis. Recent well-designed randomized trials have provided a broader evidence base for an expanding range of treatment options. Together, with new prognostic scoring systems and a greater understanding of how different patient phenotypes respond to treatment, this allows greater personalization of management. This article will discuss the current evidence on evaluation and management of MPEs.
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Affiliation(s)
- Steven Walker
- Academic Respiratory Unit, University of Bristol, Bristol, UK
| | - Anna C Bibby
- Academic Respiratory Unit, University of Bristol, Bristol, UK
| | - Nick A Maskell
- Academic Respiratory Unit, University of Bristol, Southmead Road, Bristol BS10 5NB, UK
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18
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Hak CCW, Sivakumar P, Ahmed L. Safety of indwelling pleural catheter use in patients undergoing chemotherapy: a five-year retrospective evaluation. BMC Pulm Med 2016; 16:41. [PMID: 26968653 PMCID: PMC4788821 DOI: 10.1186/s12890-016-0203-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Accepted: 03/01/2016] [Indexed: 12/13/2022] Open
Abstract
Background Indwelling pleural catheters (IPC) are increasingly becoming a first-line treatment in the management of malignant pleural effusions. Ambulatory management using IPC are increasingly used in this patient group whilst they are receiving concurrent chemotherapy. There are currently no prospective trials examining IPC safety in chemotherapy. This study’s objective is to determine if IPC insertion is safe in patients undergoing chemotherapy. Methods We conducted a retrospective analysis of all patients who underwent IPC insertion for malignant pleural effusion at our trust from September 2010 to December 2014. Data was collected on IPC insertion and removal, tumour type, systemic chemotherapy, pleural infection and other complications. Results One hundred four patients were identified, 43 in chemotherapy group and 61 in non-chemotherapy group. The incidence of pleural infection in chemotherapy group vs non-chemotherapy group, 4 (9.3 %) vs 3 (4.9 %) respectively, was not statistically different (Fisher’s exact p = 0.311). There was no significant difference in six-month infection-free duration from the date of IPC insertion (log rank p = 0.394). Overall six-month mortality in chemotherapy group was significantly lower than in non-chemotherapy group (log rank p = 0.007). Conclusions This is the second largest retrospective case–control series that concludes systemic chemotherapy is safe in patients with IPC undergoing chemotherapy.
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Affiliation(s)
- Charleen Chan Wah Hak
- Respiratory Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK. .,School of Medicine, King's College London, London, UK.
| | - Parthipan Sivakumar
- Respiratory Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK.,School of Medicine, King's College London, London, UK
| | - Liju Ahmed
- Respiratory Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK.,School of Medicine, King's College London, London, UK
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19
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Andrade Neto JD, Terra RM, Teixeira RM, Pereira SV, Pego-Fernandes PM. Safety Profile of the Use of Iodopovidone for Pleurodesis in Patients with Malignant Pleural Effusion. Respiration 2015; 90:369-75. [DOI: 10.1159/000440727] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 08/18/2015] [Indexed: 11/19/2022] Open
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20
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Rial MB, Lamela IP, Fernández VL, Arca JA, Delgado MN, Pombo CV, Hernández CR, Fernández-Villar A. Management of malignant pleural effusion by an indwelling pleural catheter: A cost-efficiency analysis. Ann Thorac Med 2015; 10:181-4. [PMID: 26229560 PMCID: PMC4518348 DOI: 10.4103/1817-1737.160837] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 04/30/2015] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND For patients that are expected to survive for longer, the risk of complications combined with the need for more vacuum drainage bottles have become barriers to the placement of indwelling pleural catheter (IPC), since these could increase costs. OBJETIVES The objective of the current article is to determine the cost and efficiency of treating malignant pleural effusion (MPE) with IPC in Spanish hospitals. METHODS We compared the cost associated with the use of IPC per outpatient and per inpatient. We analyzed the number of consultations, length of hospital stay, and outcome of the procedure. RESULTS Fifty-five patients were recruited. Spontaneous pleurodesis was achieved in 34.4% of the cases. Post-catheterization complications were observed in 7.2%. Supplementary procedures were unnecessary and 87.7% of the patients reported improved dyspnea. In 64.9% of the cases, the IPCs were inserted during hospitalization with a median hospitalization time of 4 days (1-7.5). There were differences in the number of visits with more consultations being observed in the outpatient group. There was no difference in the number of vacuum drainage bottles used. The complications supposed a cost increase of €1045.6 per outpatient and €432.54 per inpatient. The overall average cost of treatment per outpatient was €3310.2 and €5450.3 per inpatient. CONCLUSIONS The treatment with IPC was effective, safe, without need of any more procedures and led to improved dyspnea in more than 85% of the patients. The cost is lower in the outpatient group, although complications represent an increased cost in both groups.
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Affiliation(s)
- Maribel Botana Rial
- Department of Pneumology, Bronchopleural Unit, Respiratory and Infectious Disease Research Group, Bio-medical Research Institute of Vigo (IBIV), Complexo Hospitalario Universitario de Vigo (CHUVI), Vigo, Spain
| | - Isaura Parente Lamela
- Department of Pneumology, Bronchopleural Unit, Complexo Hospitalario Universitario de Ourense (CHOU), Ourense, Spain
| | - Virginia Leiro Fernández
- Department of Pneumology, Bronchopleural Unit, Respiratory and Infectious Disease Research Group, Bio-medical Research Institute of Vigo (IBIV), Complexo Hospitalario Universitario de Vigo (CHUVI), Vigo, Spain
| | - José Abal Arca
- Department of Pneumology, Bronchopleural Unit, Complexo Hospitalario Universitario de Ourense (CHOU), Ourense, Spain
| | - Manuel Núñez Delgado
- Department of Pneumology, Bronchopleural Unit, Respiratory and Infectious Disease Research Group, Bio-medical Research Institute of Vigo (IBIV), Complexo Hospitalario Universitario de Vigo (CHUVI), Vigo, Spain
| | - Carlos Vilariño Pombo
- Department of Pneumology, Bronchopleural Unit, Respiratory and Infectious Disease Research Group, Bio-medical Research Institute of Vigo (IBIV), Complexo Hospitalario Universitario de Vigo (CHUVI), Vigo, Spain
| | - Cristina Ramos Hernández
- Department of Pneumology, Bronchopleural Unit, Respiratory and Infectious Disease Research Group, Bio-medical Research Institute of Vigo (IBIV), Complexo Hospitalario Universitario de Vigo (CHUVI), Vigo, Spain
| | - Alberto Fernández-Villar
- Department of Pneumology, Bronchopleural Unit, Respiratory and Infectious Disease Research Group, Bio-medical Research Institute of Vigo (IBIV), Complexo Hospitalario Universitario de Vigo (CHUVI), Vigo, Spain
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21
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De Heer M, Cornelissen R, Hoogsteden HC, van den Toorn LM. Management of recurrent malignant pleural effusions with a tunneled indwelling pleural catheter. World J Respirol 2015; 5:135-139. [DOI: 10.5320/wjr.v5.i2.135] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Revised: 12/02/2014] [Accepted: 03/20/2015] [Indexed: 02/06/2023] Open
Abstract
In this review, we report on the use of indwelling pleural catheters in the treatment of malignant pleural effusions. We describe the most commonly used catheter. Also, treatment with indwelling pleural catheters as compared to talc pleurodesis is reviewed. A comparison of efficacy, costs, effects on quality of life, and complications is made. Only one randomized controlled trial comparing the two is available up to date, but several are underway. We conclude that treatment for malignant pleural effusions with indwelling pleural catheters is a save, cost-effective, and patient-friendly method, with low complication rates.
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22
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McPhillips D, Breen D. Indwelling pleural catheters for malignant pleural effusion. Int J Palliat Nurs 2015; 21:266, 268-70. [DOI: 10.12968/ijpn.2015.21.6.266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Pleural effusions are a common cause of symptoms in patients with malignancy and can adversely affect quality of life. However, not all effusions in the setting of malignancy are due to the cancer itself and therefore it is essential to perform an extensive assessment to diagnose the underlying aetiology. There are a number of treatment options available to manage a malignant effusion and reduce the associated symptomatology. The choice of intervention depends on a number of factors and, in particular, patient preference. In this paper, we will discuss the role of an indwelling pleural catheter in the outpatient management of individuals with malignant effusions.
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Affiliation(s)
- Dympna McPhillips
- Oncology Clinical Nurse Specialist, Oncology Unit, Cavan General Hospital, Cavan, Ireland
| | - David Breen
- Consultant Respiratory Physician, Interventional Pulmonologist, Interventional Respiratory Unit, Galway University Hospitals, Newcastle Road, Galway, Ireland
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23
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Corcoran JP, Psallidas I, Wrightson JM, Hallifax RJ, Rahman NM. Pleural procedural complications: prevention and management. J Thorac Dis 2015; 7:1058-67. [PMID: 26150919 PMCID: PMC4466427 DOI: 10.3978/j.issn.2072-1439.2015.04.42] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 04/08/2015] [Indexed: 12/11/2022]
Abstract
Pleural disease is common with a rising case frequency. Many of these patients will be symptomatic and require diagnostic and/or therapeutic procedures. Patients with pleural disease present to a number of different medical specialties, and an equally broad range of clinicians are therefore required to have practical knowledge of these procedures. There is often underestimation of the morbidity and mortality associated with pleural interventions, even those regarded as being relatively straightforward, with potentially significant implications for processes relating to patient safety and informed consent. The advent of thoracic ultrasound (TUS) has had a major influence on patient safety and the number of physicians with the necessary skill set to perform pleural procedures. As the variety and complexity of pleural interventions increases, there is increasing recognition that early specialist input can reduce the risk of complications and number of procedures a patient requires. This review looks at the means by which complications of pleural procedures arise, along with how they can be managed or ideally prevented.
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24
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Froudarakis ME. Should we really compare indwelling pleural catheters to any pleurodesis? Respiration 2014; 88:18-21. [PMID: 24821005 DOI: 10.1159/000362693] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Marios E Froudarakis
- Department of Pneumonology, Medical School of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece
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