1
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Larisch C, Riedel J, Hofmann HS, Ried M. [Management of Malignant Pleural Effusion]. Zentralbl Chir 2024; 149:315-327. [PMID: 38838699 DOI: 10.1055/a-1990-5057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2024]
Abstract
Malignant pleural effusion is a common diagnosis in metastasized cancers. It is always of palliative character. Main symptoms are dyspnoea and reduced quality of life. Diagnosis is made by ultrasound-guided puncture of the pleural effusion (cytology) and often video-assisted thoracic surgery with biopsy of the pleural surface (histology). The goal of treatment is a fast, sustainable, minimally invasive, patient-centred therapy that increases quality of life. Besides systemic therapy and best supportive care the patient can be treated with local therapy including either pleurodesis (via drainage or VATS) or an indwelling-pleural catheter (IPC). Decision for one of these procedures is made upon performance index (ECOG), expandability of the lung, prognosis and the patient's wish. For the first technique, the lung must be expandable. The latter one (IPC) can be implanted both with expandable and trapped lung. Both are similarly effective in symptom control.
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2
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Makkar P, Schwartz J, Shayani K, Imran S, Flynn J, Chu J, Chawla M, Lee R. Indwelling tunneled pleural catheter infections and host related factors. Respir Med 2024; 224:107579. [PMID: 38408706 PMCID: PMC11036657 DOI: 10.1016/j.rmed.2024.107579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 02/11/2024] [Accepted: 02/20/2024] [Indexed: 02/28/2024]
Affiliation(s)
- Priyanka Makkar
- Section of Interventional Pulmonology, Pulmonary Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jacob Schwartz
- Department of Pulmonary and Critical Care Medicine, Lenox Hill Hospital, New York, NY, USA
| | - Kevin Shayani
- Department of Pulmonary and Critical Care Medicine, Lenox Hill Hospital, New York, NY, USA.
| | - Saira Imran
- Section of Interventional Pulmonology, Pulmonary Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jessica Flynn
- Department of Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Joanne Chu
- Department of Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Mohit Chawla
- Section of Interventional Pulmonology, Pulmonary Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Robert Lee
- Section of Interventional Pulmonology, Pulmonary Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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3
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Sethi DK, Webber MA, Mishra EK. Indwelling pleural catheter infection and colonisation: a clinical practice review. J Thorac Dis 2024; 16:2196-2204. [PMID: 38617774 PMCID: PMC11009600 DOI: 10.21037/jtd-23-1761] [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: 11/15/2023] [Accepted: 02/02/2024] [Indexed: 04/16/2024]
Abstract
Indwelling pleural catheters (IPCs) are used in the management of malignant pleural effusions, but they can become infected in 5.7% of cases. This review aims to provide a summary of the development of IPC infections and their microbiology, diagnosis and management. IPC infections can be deep, involving the pleural space, or superficial. The former are of greater clinical concern. Deep infection is associated with biofilm formation on the IPC surface and require longer courses of antibiotic treatment. Mortality from infections is low and it is common for patients to undergo pleurodesis following a deep infection. The diagnosis of pleural infections is based upon positive IPC pleural fluid cultures, changes in pleural fluid appearance and biochemistry, and signs or symptoms suggestive of infection. IPCs can also become colonised, where bacteria are grown from pleural fluid drained via an IPC but without evidence of infection. It is important to distinguish between infection and colonisation clinically, and though infections require antibiotic treatment, colonisation does not. It is unclear what proportion of IPCs become colonised. The most common causes of IPC infection and colonisation are Staphylococcus aureus and Coagulase-negative Staphylococci respectively. The management of deep IPC infections requires prolonged antibiotic therapy and the drainage of infected fluid, usually via the IPC. Intrapleural enzyme therapy (DNase and fibrinolytics) can be used to aid drainage. IPCs rarely need to be removed and patients can generally be managed as outpatients. Work is ongoing to study the incidence and significance of IPC colonisation. Other topics of interest include topical mupirocin to prevent IPC infections, and whether IPCs can be designed to limit infection risk.
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Affiliation(s)
- Dheeraj K. Sethi
- Quadram Institute Bioscience, Norwich, UK
- Department of Respiratory Medicine, Norfolk and Norwich University Hospitals Foundation Trust, Norwich, UK
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Mark A. Webber
- Quadram Institute Bioscience, Norwich, UK
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Eleanor K. Mishra
- Department of Respiratory Medicine, Norfolk and Norwich University Hospitals Foundation Trust, Norwich, UK
- Norwich Medical School, University of East Anglia, Norwich, UK
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4
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Lau EPM, Faber S, Charlesworth C, Morey S, Vekaria S, Filion P, Chakera A, Lee YCG. Topical antibiotics prophylaxis for infections of indwelling pleural/peritoneal catheters (TAP-IPC): A pilot study. Respirology 2024; 29:176-182. [PMID: 37696757 DOI: 10.1111/resp.14595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 08/28/2023] [Indexed: 09/13/2023]
Abstract
BACKGROUND AND OBJECTIVE Indwelling pleural catheter (IPC) and indwelling peritoneal catheter (IPeC) have established roles in the management of malignant pleural and peritoneal effusions but catheter-related infections remain a major concern. Topical mupirocin prophylaxis has been shown to reduce peritoneal dialysis catheter infections. This study aimed to assess the (i) compatibility of IPC with mupirocin and (ii) feasibility, tolerability and compliance of topical mupirocin prophylaxis in patients with an IPC or IPeC. METHODS (i) Three preparations of mupirocin were applied onto segments of IPC thrice weekly and examined with scanning electron microscope (SEM) at different time intervals. (ii) Consecutive patients fitted with IPC or IPeC were given topical mupirocin prophylaxis to apply to the catheter exit-site following every drainage/dressing change (at least twice weekly) and followed up for 6 months. RESULTS (i) No detectable structural catheter damage was found with mupirocin applied for up to 6 months. (ii) Fifty indwelling catheters were inserted in 48 patients for malignant pleural (n = 41) and peritoneal (n = 9) effusions. Median follow-up was 121 [median, IQR 19-181] days. All patients tolerated mupirocin well; one patient reported short-term local tenderness. Compliance was excellent with 95.8% of the 989 scheduled doses delivered. Six patients developed catheter-related pleural (n = 3), concurrent peritoneal/local (n = 1) and skin/tract (n = 2) infections from Streptococcus mitis (with Bacillus species or anaerobes), Staphylococcus aureus, Klebsiella pneumoniae and Pseudomonas aeruginosa. CONCLUSION This first study of long-term prevention of IPC- or IPeC-related infections found topical mupirocin prophylaxis feasible and well tolerated. Its efficacy warrants future randomized studies.
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Affiliation(s)
- Estee P M Lau
- Pleural Medicine Unit, Institute for Respiratory Health, Perth, Western Australia, Australia
- School of Medical and Health Sciences, Edith Cowan University, Perth, Western Australia, Australia
| | - Sam Faber
- Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Chloe Charlesworth
- Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Sue Morey
- Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Sona Vekaria
- Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
- Department of Pharmacy, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Pierre Filion
- PathWest Laboratory Medicine, QEII Medical Centre, Perth, Western Australia, Australia
| | - Aron Chakera
- Renal Unit, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
- School of Medicine, University of Western Australia, Perth, Western Australia, Australia
| | - Y C Gary Lee
- Pleural Medicine Unit, Institute for Respiratory Health, Perth, Western Australia, Australia
- Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
- School of Medicine, University of Western Australia, Perth, Western Australia, Australia
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5
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Alexander M, Ishisaka Y, Miyakawa L, Rothman A. Assessing Factors That May Impact Physician-based Decisions for Placing Indwelling Pleural Catheters. J Bronchology Interv Pulmonol 2024; 31:39-48. [PMID: 37185887 DOI: 10.1097/lbr.0000000000000926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 03/27/2023] [Indexed: 05/17/2023]
Abstract
INTRODUCTION Malignant pleural effusion is a common finding in patients with advanced cancer and is a frequent cause of dyspnea. Current guidelines indicate thoracentesis for symptomatic patients, while indwelling pleural catheters (IPC) are recommended for patients who develop pleural fluid re-accumulation. IPC maintenance, however, requires a significant level of financial and social support. This study aims to analyze potential influencing factors that may play a role in the decision for placing IPCs in patients with recurrent malignant pleural effusions. METHODS This study retrospectively collected baseline sociodemographic and laboratory data in patients who underwent thoracentesis for malignant pleural effusion from August 2016 to October 2021, and selected patients who presented with re-accumulation of pleural fluid within 30 days or had a pulmonary physician's note documenting that IPC is a potential management option. Of these selected patients (IPC candidates), we stratified patients who underwent IPC placement and those who did not, and performed statistical analysis between these 2 groups. RESULTS One hundred seventy-six patients who underwent thoracentesis were regarded as IPC candidates. Almost all baseline sociodemographic characteristics, including ethnicity ( P =0.637), sex ( P =0.655), and marital status ( P =0.773) were similar between the 2 groups, but significantly higher ECOG scores ( P =0.049) were noted in the IPC group. No statistically significant differences were noted in age, body mass index, platelet, PTT, international normalized ratio, creatinine, white blood cell, red blood cells, fluid protein, or fluid lactate dehydrogenase. Fluid albumin ( P =0.057) and serum neutrophil:lymphocyte ratio ( P =0.003) were significantly higher in patients without IPC placement. CONCLUSION This study did not recognize any baseline sociodemographic factors that may contribute to the decision to place IPCs.
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Affiliation(s)
| | | | - Lina Miyakawa
- Department of Pulmonary & Critical Care Medicine, Mount Sinai Beth Israel
| | - Adam Rothman
- Department of Pulmonary & Critical Care Medicine, Mount Sinai Morningside-West, New York, NY
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Hofmann HS, M. Scheule A, Markowiak T, Ried M. The Treatment of Malignant Pleural Effusion With Permanent Indwelling Pleural Catheters. DEUTSCHES ARZTEBLATT INTERNATIONAL 2022; 119:595-600. [PMID: 35734918 PMCID: PMC9749840 DOI: 10.3238/arztebl.m2022.0229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 03/07/2022] [Accepted: 05/10/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND 40 000 to 60 000 people develop malignant pleural effusion (MPE) in Germany each year. The most common causes are lung cancer and breast cancer. Patients with pleural carcinomatosis have a median survival time of four months. METHODS We investigated the current health services situation regarding treatment with indwelling pleural catheters (IPC) versus talc pleurodesis (TP) in Germany based on registry data from the Federal Statistical Office, the Pleural Tumor Registry of the German Society for Thoracic Surgery, and the IPC registry of the ewimed GmbH company. In addition, we conducted a selective literature review on IPC and TP. RESULTS The symptoms of dyspnea and thoracic pressure determine the need for therapy in MPE. Both TP and IPC are effective treatment options for MPE. Both therapeutic procedures are considered equally effective with respect to the relief of dyspnea, post-interventional quality of life, and complication rates. TP yields a higher rate of successful pleurodesis than IPC (relative risk: 1.56; 95% confidence interval: [1.26; 1.92]; p < 0.0001), while patients who receive an IPC stay in the hospital for a shorter time than those who undergo TP (a difference of slightly more than two days). The survival of patients with MPE is not affected by which of the two local therapeutic procedures is chosen. CONCLUSION The indication for either IPC or TP needs to be determined individually for each patient on the basis of his or her general condition, symptoms, clinical situation ("trapped lung"), and prognosis.
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Affiliation(s)
- Hans-Stefan Hofmann
- University Hospital Regensburg, Department of Thoracic Surgery,*Department for Thoracic Surgery University Hospital of Regensburg Franz-Josef-Strauss-Allee 11 93053 Regensburg
| | | | - Till Markowiak
- University Hospital Regensburg, Department of Thoracic Surgery
| | - Michael Ried
- University Hospital Regensburg, Department of Thoracic Surgery
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7
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Jacobs B, Sheikh G, Youness HA, Keddissi JI, Abdo T. Diagnosis and Management of Malignant Pleural Effusion: A Decade in Review. Diagnostics (Basel) 2022; 12:1016. [PMID: 35454064 PMCID: PMC9030780 DOI: 10.3390/diagnostics12041016] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 04/12/2022] [Accepted: 04/12/2022] [Indexed: 02/04/2023] Open
Abstract
Malignant pleural effusion (MPE) is a common complication of thoracic and extrathoracic malignancies and is associated with high mortality. Treatment is mainly palliative, with symptomatic management achieved via effusion drainage and pleurodesis. Pleurodesis may be hastened by administering a sclerosing agent through a thoracostomy tube, thoracoscopy, or an indwelling pleural catheter (IPC). Over the last decade, several randomized controlled studies shaped the current management of MPE in favor of an outpatient-based approach with a notable increase in IPC usage. Patient preferences remain essential in choosing optimal therapy, especially when the lung is expandable. In this article, we reviewed the last 10 to 15 years of MPE literature with a particular focus on the diagnosis and evolving management.
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Affiliation(s)
| | | | | | | | - Tony Abdo
- Section of Pulmonary, Critical Care and Sleep Medicine, The University of Oklahoma Health Sciences Center and The Oklahoma City VA Health Care System, Oklahoma City, OK 73104, USA; (B.J.); (G.S.); (H.A.Y.); (J.I.K.)
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8
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Sundaralingam A, Bedawi EO, Harriss EK, Munnavar M, Rahman NM. The Frequency, Risk Factors and Management of Complications from Pleural Procedures. Chest 2021; 161:1407-1425. [PMID: 34896096 DOI: 10.1016/j.chest.2021.11.031] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 11/11/2021] [Accepted: 11/14/2021] [Indexed: 10/19/2022] Open
Abstract
Pleural disease is a common presentation and spans a heterogenous population across broad disease entities but a common feature is the requirement for interventional procedures. Despite the frequency of such procedures, there is little consensus on rates of complications and risk factors associated with such complications. Here follows a narrative review based on a structured search of the literature. Searches were limited to 2010 onwards, in recognition of the sea-change in procedural complications following the mainstream use of thoracic ultrasound (US). Procedures of interest were limited to thoracocentesis, intercostal drains (ICD), indwelling pleural catheters (IPC) and local anaesthetic thoracoscopy (LAT). 4308 studies were screened, to identify 48 studies for inclusion. Iatrogenic pneumothorax (PTX) remains the commonest complication following thoracocentesis: 3.3% (95% CI, 3.2-3.4), though PTX requiring intervention was rare: 0.3% (95% CI, 0.2-0.4) when the procedure was US guided. Drain blockage and displacement are the commonest complications following ICD insertion (6.3%, and 6.8%, respectively). IPC related infections can be a significant problem: 5.8% (95% CI, 5.1-6.7), however most cases can be managed without removal of the IPC. LAT has an overall mortality of 0.1% (95% CI, 0.03-0.3). Data on safety and complication rates in procedural interventions are limited by methodological problems and novel methods to study this topic bears consideration. Whilst complications remain rare events, once encountered, they have the potential to rapidly escalate. It is of paramount importance for operators to prepare and have in place plans for such events, to ensure high quality and above all, safe care.
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Affiliation(s)
- Anand Sundaralingam
- Oxford Pleural Unit, Oxford Centre for Respiratory Medicine, Churchill Hospital.
| | - Eihab O Bedawi
- Oxford Pleural Unit, Oxford Centre for Respiratory Medicine, Churchill Hospital
| | | | | | - Najib M Rahman
- Oxford Pleural Unit, Oxford Centre for Respiratory Medicine, Churchill Hospital; University of Oxford, NIHR Oxford Biomedical Research Centre
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9
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Jayakrishnan B, Kashoob M, Al-Sukaiti R, Al-Mubaihsi S, Kakaria A, Al-Ghafri A, Al-Lawati Y. Percutaneous Ultrasound-guided Pigtail Catheter for Pleural Effusions: Efficacy and Safety. Oman Med J 2021; 36:e248. [PMID: 33898060 PMCID: PMC8053257 DOI: 10.5001/omj.2021.19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 07/11/2020] [Indexed: 11/22/2022] Open
Abstract
Objectives Small-bore pigtail catheters are now being used more frequently for draining pleural effusions. This study aimed to measure the efficacy, safety, and tolerability of these devices in different clinical conditions. Methods We retrospectively collected data from 141 patients with pleural effusions of various etiologies who underwent ultrasound-guided pigtail catheter insertion at Sultan Qaboos University Hospital, Muscat, Oman. Results The majority 109 (77.3%) of patients had exudates. The mean age was 50.0±18.6 years in patients with exudates and 67.3±15.5 in patients with transudates (p < 0.001). There was no significant difference (p = 0.232) in the median drainage duration between exudates (6.0 days) and transudates (4.5 days). The incidence of pain requiring regular analgesics, pneumothorax, and blockage were 36.2% (n = 51), 2.8% (n = 4), and 0.7% (n = 1), respectively. The overall success rate of pleural effusion drainage was 90.1%. Among the 109 cases of exudative pleural effusion, 89.0% were successful compared to a 93.8% success rate among patients with transudative effusion (p = 0.737). Short-term success rates were high in all causes of effusions: lung cancer (100%), metastasis (90.0%), pleural infections (83.3%), cardiac failure (94.7%), renal disease (85.7%), and liver disease (100%). Conclusions Ultrasound-guided pigtail catheter insertion is an effective, comfortable, and safe method of draining pleural fluid. It should be considered as the first intervention if drainage of a pleural effusion is clinically indicated.
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Affiliation(s)
- B Jayakrishnan
- Department of Medicine, Sultan Qaboos University Hospital, Muscat, Oman
| | - Masoud Kashoob
- Internal Medicine Residency Program, Oman Medical Speciality Board, Muscat, Oman
| | - Rashid Al-Sukaiti
- Department of Radiology, Sultan Qaboos University Hospital, Muscat, Oman
| | - Saif Al-Mubaihsi
- Department of Medicine, Sultan Qaboos University Hospital, Muscat, Oman
| | - Anupam Kakaria
- Department of Radiology, Sultan Qaboos University Hospital, Muscat, Oman
| | - Amal Al-Ghafri
- Student, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Yasser Al-Lawati
- Student, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
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10
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Akram MJ, Khalid U, Ashraf MB, Bakar MA, Butt FM, Khan F. Predicting the survival in patients with malignant pleural effusion undergoing indwelling pleural catheter insertion. Ann Thorac Med 2020; 15:223-229. [PMID: 33381237 PMCID: PMC7720744 DOI: 10.4103/atm.atm_289_20] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 07/03/2020] [Indexed: 11/05/2022] Open
Abstract
CONTEXT Malignant pleural effusion (MPE) is a common comorbid condition in advanced malignancies with variable survival. AIMS The aim of this study was to predict the survival in patients with MPE undergoing indwelling pleural catheter (IPC) insertion. SETTINGS AND DESIGN This was a cross-sectional study conducted at Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan. METHODS One hundred and ten patients with MPE who underwent IPC insertion from January 2011 to December 2019 were reviewed. Kaplan-Meier method was used to determine the overall survival (OS) of the patient's cohort with respect to LENT score. STATISTICAL ANALYSIS USED The IBM SPSS version 20 was used for statistical analysis. RESULTS We retrospectively reviewed 110 patients who underwent IPC insertion for MPE, with a mean age of 49 ± 15 years. 76 (69.1%) patients were females, of which majority 59 (53.6%) had a primary diagnosis of breast cancer. The LENT score was used for risk stratification, and Kaplan-Meier survival curves were used to predict the OS. The proportion of patients with low-risk LENT score had 91%, 58%, and 29% survival, the moderate-risk group had 76%, 52%, and 14% survival, and in the high-risk group, 61%, 15%, and 0% patients survived at 1, 3, and 6 months, respectively. In addition, there was a statistically significant survival difference (P = 0.05) in patients who received chemotherapy pre- and post-IPC insertion. CONCLUSIONS LENT score seems to be an easy and attainable tool, capable of predicting the survival of the patients with MPE quite accurately. It can be helpful in palliating the symptoms of patients with advanced malignancies by modifying the treatment strategies.
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Affiliation(s)
- Muhammad Junaid Akram
- Department of Internal Medicine, Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, Pakistan
| | - Usman Khalid
- Department of Internal Medicine, Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, Pakistan
| | | | - Muhammad Abu Bakar
- Department of Cancer Registry and Clinical Data Management, Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, Pakistan
| | - Faheem Mahmood Butt
- Department of Internal Medicine, Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, Pakistan
| | - Faheem Khan
- Royal Blackburn Teaching Hospital, East Lancashire Hospitals, NHS Trust, England, UK
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11
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Miller RJ, Chrissian AA, Lee YCG, Rahman NM, Wahidi MM, Tremblay A, Hsia DW, Almeida FA, Shojaee S, Mudambi L, Belanger AR, Bedi H, Gesthalter YB, Gaynor M, MacKenney KL, Lewis SZ, Casal RF. AABIP Evidence-informed Guidelines and Expert Panel Report for the Management of Indwelling Pleural Catheters. J Bronchology Interv Pulmonol 2020; 27:229-245. [PMID: 32804745 DOI: 10.1097/lbr.0000000000000707] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND While the efficacy of Indwelling pleural catheters for palliation of malignant pleural effusions is supported by relatively robust evidence, there is less clarity surrounding the postinsertion management. METHODS The Trustworthy Consensus-Based Statement approach was utilized to develop unbiased, scientifically valid guidance for the management of patients with malignant effusions treated with indwelling pleural catheters. A comprehensive electronic database search of PubMed was performed based on a priori crafted PICO questions (Population/Intervention/Comparator/Outcomes paradigm). Manual searches of the literature were performed to identify additional relevant literature. Dual screenings at the title, abstract, and full-text levels were performed. Identified studies were then assessed for quality based on a combination of validated tools. Appropriateness for data pooling and formation of evidence-based recommendations was assessed using predetermined criteria. All panel members participated in development of the final recommendations utilizing the modified Delphi technique. RESULTS A total of 7 studies were identified for formal quality assessment, all of which were deemed to have a high risk of bias. There was insufficient evidence to allow for data pooling and formation of any evidence-based recommendations. Panel consensus resulted in 11 ungraded consensus-based recommendations. CONCLUSION This manuscript was developed to provide clinicians with guidance on the management of patients with indwelling pleural catheters placed for palliation of malignant pleural effusions. Through a systematic and rigorous process, management suggestions were developed based on the best available evidence with augmentation by expert opinion when necessary. In addition, these guidelines highlight important gaps in knowledge which require further study.
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Affiliation(s)
- Russell J Miller
- Department of Pulmonary Medicine, Naval Medical Center San Diego
- Department of Medicine, University of California San Diego, San Diego
| | - Ara A Chrissian
- Department of Medicine, Division of Pulmonary and Critical Care, Loma Linda University Medical Center, Loma Linda
| | - Y C Gary Lee
- Centre for Respiratory Research, School of Medicine
- Institute for Respiratory Health, University of Western Australia
- Department of Respiratory Medicine, Sir Charles Gairdner Hospital
- Edith Cowan University, Perth, WA, Australia
| | - Najib M Rahman
- Oxford Respiratory Trials Unit, Nuffield Department of Experimental Medicine, University of Oxford, Oxford, UK
| | - Momen M Wahidi
- Department of Internal Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University Medical Center, Durham
| | - Alain Tremblay
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - David W Hsia
- Harbor-University of California Los Angeles Medical Center
- Los Angeles Biomedical Research Institute at Harbor-University of California Los Angeles, Torrance
| | | | - Samira Shojaee
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Virginia Commonwealth University, Richmond, VA
| | - Lakshmi Mudambi
- Section of Pulmonary & Critical Care Medicine, VA Portland Health Care System
- Department of Medicine, Division of Pulmonary & Critical Care Medicine, Oregon Health & Science University, Portland, OR
| | - Adam R Belanger
- Section of Interventional Pulmonology, Department of Medicine, University of North Carolina, Chapel Hill, NC
| | - Harmeet Bedi
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Stanford University School of Medicine, Stanford
| | - Yaron B Gesthalter
- Department of Pulmonary, Critical Care, Allergy and Sleep Medicine, University of California San Francisco, San Francisco, CA
| | | | - Karen L MacKenney
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Roberto F Casal
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
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12
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Akram MJ, Khalid U, Bakar MA, Butt FM, Ashraf MB, Khan F. Indications and clinical outcomes of indwelling pleural catheter placement in patients with malignant pleural effusion in a cancer setting hospital. CLINICAL RESPIRATORY JOURNAL 2020; 14:1040-1049. [PMID: 32750225 DOI: 10.1111/crj.13239] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 07/11/2020] [Accepted: 07/27/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND The placement of indwelling pleural catheters (IPC) is an effective outpatient approach for the management of malignant pleural effusions (MPE). AIMS The indications and outcome of IPC in patients with MPE. Risk stratifications, prevention and management of IPC-related complications. METHODS We retrospectively reviewed the clinical data of patients with MPE who underwent IPC insertion from July 2011 to July 2019. The multivariable logistic regression model was used to identify the independent risk factors associated with IPC infection and the Kaplan-Meier method to determine the overall survival. RESULTS A total of 102 patients underwent IPC insertion during the stipulated period and the mean age was 50.49 ± 14.36 years. Seventy-one (69.6%) were females. The indications were Trap Lung in 38 (37.3%), failed talc pleurodesis in 28 (27.5%) and as a primary intervention in 36 (35.3%). The infection rate was 25.5%, of which 65.4% patients had nosocomial infections. Post-IPC overall median survival time was 9.0 ± 2.50 weeks with highest in patients with trap lung (18 ± 1.50 weeks). In multivariable analysis, following variables were identified as a significant independent risk factor for IPC infection: Multiloculated MPE (AOR 2.80; 95%CI (1.00-9.93), 0.04), trap lung (AOR 7.57; 95%CI (1.39-41.25), 0.01), febrile neutropenia (FN) (AOR 28.55; 95%CI (4.23-19.74), 0.001), IPC domiciliary education (AOR 0.18; 95%CI (0.05-0.66), 0.001) and length of hospital stay (AOR 1.16; 95%CI (1.01-1.33), 0.03). CONCLUSION IPC insertion is an effective management for MPE with reasonable survival benefits. Infection is the most common complication, of which mostly are nosocomial infections with higher incidence in multiloculated effusions, trap lung, FN and with lack of domiciliary IPC care education.
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Affiliation(s)
- Muhammad Junaid Akram
- Fellow College of Physicians and Surgeons Pakistan (Internal Medicine), Member of Royal College of Physician United Kingdom, Fellow Pulmonology, Department of Internal Medicine, Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, Pakistan
| | - Usman Khalid
- Fellow College of Physicians and Surgeons Pakistan (Internal Medicine), Fellow Pulmonology, Department of Internal Medicine, Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, Pakistan
| | - Muhammad Abu Bakar
- BS (Hons), M.Sc. Epidemiology and Biostatistics (South Africa) Biostatistician and Cancer Epidemiologist, Department of Cancer Registry and Clinical Data Management, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan
| | - Faheem Mahmood Butt
- Diplomate American Board of Internal Medicine and Pulmonology. Consultant Pulmonology, Department of Internal Medicine, Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, Pakistan
| | - Mohammad Bilal Ashraf
- Diplomate American Board of internal medicine, Pulmonology and Critical Care, Consultant Pulmonology & Critical Care Medicine, Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, Pakistan
| | - Faheem Khan
- Fellow of College of Chest Physicians, Member Royal College of Physicians Ireland, Consultant Pulmonology, Shaukat Khanum Memorial Cancer Hospital & Research Center, Lahore, Pakistan
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Langner S, Koschel D, Kleymann J, Tausche K, Karl S, Frenzen F, Heberling M, Schulte-Hubbert B, Halank M, Kolditz M. [Complications after Indwelling Pleural Catheter Implant for Symptomatic Recurrent Benign and Malignant Pleural Effusions]. Pneumologie 2020; 74:864-870. [PMID: 32663890 DOI: 10.1055/a-1201-3682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Implant of indwelling pleural catheters (IPC) represents an established therapy method in addition to pleurodesis for symptomatic recurrent benign and malignant pleural effusions (BPE and MPE).There are only few studies on IPC safety during follow-up, especially with regard to infection and pneumothorax rates.The aim of our investigation was to determine the complication frequency after IPC implant and its predictive factors in patients with BPE vs. MPE. METHODS Retrospective analysis of all IPC implantations in the pneumology department at the University Hospital Dresden during 2015 - 2018. RESULTS An IPC was implanted in 86 patients (43 m/f each; age 66.9 ± 13.3 years) with symptomatic BPE and MPE. BPE and MPE was present in 12.8 % (11/86) and 87.2 % (75/86) of the patients, respectively.A predominantly small and asymptomatic pneumothorax was detectable as an immediate complication in 43/86 (50 %) of patients; 34/43 (79 %) of patients did not require any specific therapy. For 9/43 patients, IPC suction was required for a median period of three days; 8/43 patients had a large pneumothorax with partial or complete regression after a median period of two days.Catheter infection developed in 15.1 % (13/86) of the total group and 36.4 % (4/11) of the BPE vs. 12 % (9/75) of the MPE after a median period of 87 (BPE/MPE 116/87) days. This was more common in BPE (p = 0.035), large pneumothorax (4/8 patients; p = 0.015) and longer catheter dwell times (124 ± 112 vs. 71 ± 112 days; p = 0.07). CONCLUSION Small pneumothoraxes are frequent after IPC implantation, but usually do not require specific therapy. IPC infection was detected in 15.1 % of all patients after a median period of 87 days. This was more common in patients with BPE, longer catheter dwell times and large pneumothorax.
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Affiliation(s)
- S Langner
- Bereich Pneumologie, Medizinische Klinik I, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Dresden
| | - D Koschel
- Bereich Pneumologie, Medizinische Klinik I, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Dresden.,Fachkrankenhaus Coswig, Abteilung Innere Medizin und Pneumologie, Lungenzentrum, Coswig
| | - J Kleymann
- Bereich Pneumologie, Medizinische Klinik I, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Dresden
| | - K Tausche
- Bereich Pneumologie, Medizinische Klinik I, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Dresden
| | - S Karl
- Bereich Pneumologie, Medizinische Klinik I, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Dresden
| | - F Frenzen
- Bereich Pneumologie, Medizinische Klinik I, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Dresden
| | - M Heberling
- Bereich Pneumologie, Medizinische Klinik I, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Dresden
| | - B Schulte-Hubbert
- Bereich Pneumologie, Medizinische Klinik I, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Dresden
| | - M Halank
- Bereich Pneumologie, Medizinische Klinik I, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Dresden
| | - M Kolditz
- Bereich Pneumologie, Medizinische Klinik I, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Dresden
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