1
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Piggott LM, Hayes C, Greene J, Fitzgerald DB. Malignant pleural disease. Breathe (Sheff) 2023; 19:230145. [PMID: 38351947 PMCID: PMC10862126 DOI: 10.1183/20734735.0145-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 01/02/2024] [Indexed: 02/16/2024] Open
Abstract
Malignant pleural disease represents a growing healthcare burden. Malignant pleural effusion affects approximately 1 million people globally per year, causes disabling breathlessness and indicates a shortened life expectancy. Timely diagnosis is imperative to relieve symptoms and optimise quality of life, and should give consideration to individual patient factors. This review aims to provide an overview of epidemiology, pathogenesis and suggested diagnostic pathways in malignant pleural disease, to outline management options for malignant pleural effusion and malignant pleural mesothelioma, highlighting the need for a holistic approach, and to discuss potential challenges including non-expandable lung and septated effusions.
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Affiliation(s)
- Laura M. Piggott
- Department of Respiratory Medicine, Tallaght University Hospital, Dublin, Ireland
- Department of Respiratory Medicine, St. James's Hospital, Dublin, Ireland
- These authors contributed equally
| | - Conor Hayes
- Department of Respiratory Medicine, Tallaght University Hospital, Dublin, Ireland
- Department of Respiratory Medicine, St. James's Hospital, Dublin, Ireland
- These authors contributed equally
| | - John Greene
- Department of Oncology, Tallaght University Hospital, Dublin, Ireland
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2
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Asciak R, Bedawi EO, Bhatnagar R, Clive AO, Hassan M, Lloyd H, Reddy R, Roberts H, Rahman NM. British Thoracic Society Clinical Statement on pleural procedures. Thorax 2023; 78:s43-s68. [PMID: 37433579 DOI: 10.1136/thorax-2022-219371] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/13/2023]
Affiliation(s)
- Rachelle Asciak
- Respiratory Medicine, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | - Eihab O Bedawi
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | | | | | - Maged Hassan
- Chest Diseases Department, Alexandria University Faculty of Medicine, Alexandria, Egypt
| | - Heather Lloyd
- Worcestershire Acute Hospitals NHS Trust, Worcester, UK
| | - Raja Reddy
- Kettering General Hospital NHS Foundation Trust, Kettering, UK
| | - Helen Roberts
- Sherwood Forest Hospitals NHS Foundation Trust, Sutton-In-Ashfield, UK
| | - Najib M Rahman
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Oxford NIHR Biomedical Research Centre, Oxford, UK
- Oxford Respiratory Trials Unit, University of Oxford, Oxford, UK
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3
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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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4
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Noninvasive Management of Fractured Indwelling Tunneled Pleural Catheter Valve. Case Rep Pulmonol 2022; 2022:2541285. [PMID: 35996613 PMCID: PMC9392587 DOI: 10.1155/2022/2541285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 07/15/2022] [Indexed: 11/23/2022] Open
Abstract
Tunneled indwelling pleural catheters (IPCs) are frequently used to palliate symptomatic dyspnea due to recurrent pleural effusions. The drainage valve of IPCs is an important component of the catheter as fracture of the valve leads to malfunctioning of the IPCs. Replacement of the catheter includes risks such as pain, infection, pneumothorax, and procedure cost. We report two cases of malfunctioning tunneled IPC drainage valves repaired by our noninvasive method and discuss the need for a repair kit and a standardized approach to this repair in case of nonavailability of repair kits.
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5
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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:diagnostics12041016. [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
- Correspondence: ; Tel.: +1-405-271-6173; Fax: +1-405-271-5892
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6
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Radiological Reporting of Urgencies Related to Medical Devices: Commentary on a Possible Systematic Approach. ACTA ACUST UNITED AC 2021; 7:268-277. [PMID: 34209969 PMCID: PMC8293404 DOI: 10.3390/tomography7030024] [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: 04/02/2021] [Revised: 06/21/2021] [Accepted: 06/25/2021] [Indexed: 11/27/2022]
Abstract
Most medical devices are routinely recognized on radiological images and described as normal findings in the radiological report, but sometimes they can cause patient access to the emergency department. Multiple possible complications have been described and most of them require prompt recognition by radiologists for proper clinical management. This commentary proposes a systematic approach to radiological reporting of the most common emergent complications related to medical devices with the intent to avoid the omission of important findings in the final radiological report.
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7
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Dorta Luis IJ, Carretero PGL, Pã Rez CLM, Cabezudo IHN, Figueroa ALP, Palau AGL. Pulling out a broken catheter using interventional radiology in a preterm. Neonatal intensive care. LA PEDIATRIA MEDICA E CHIRURGICA 2021; 43. [PMID: 34002600 DOI: 10.4081/pmc.2021.255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 04/20/2021] [Indexed: 11/23/2022] Open
Abstract
There are different indications for the placement of a pleural drainage. It is indicated in a massive pneumothorax or a pleural effusion, and a tunnelled indwelling pleural catheter is put in place. As in any procedure, complications may occur. A broken catheter is a rare one, and when it occurs, it has to be removed by thoracoscopic surgery. This article describes the first case of a removal of a fractured pleural catheter in a preterm newborn with a bilateral pneumothorax using interventional radiology. We propose an alternative way less invasive that could enable a shorter recovery time with fewer complications.
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Affiliation(s)
- Ismael Josà Dorta Luis
- Department of Pediatrics, Nuestra Señora de Candelaria University Hospital, Santa Cruz de Tenerife.
| | | | - Carmen Luz Marrero Pã Rez
- Department of Neonatology, Nuestra Señora de Candelaria University Hospital, Santa Cruz de Tenerife.
| | | | - Antonio Lã Pez Figueroa
- Department of Pediatric Radiology, Nuestra Señora de Candelaria University Hospital, Santa Cruz de Tenerife.
| | - Andrea Gonzà Lez Palau
- Department of Pediatrics, Nuestra Señora de Candelaria University Hospital, Santa Cruz de Tenerife.
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8
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Retained Granulation Cuff as a Complication of Indwelling Pleural Catheter Removal. J Bronchology Interv Pulmonol 2021; 28:156-159. [PMID: 33122600 DOI: 10.1097/lbr.0000000000000723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 09/21/2020] [Indexed: 11/26/2022]
Abstract
Recurrent pleural effusions can be managed with indwelling tunneled pleural catheters (IPC), with some patients undergoing IPC removal after appropriate palliation has occurred. Little data exists regarding complications related to IPC removal. We report on retained granulation cuffs after successful IPC removal. We identified 122 IPC removals of which 6 (4.9%) were complicated by retained granulation cuff. No additional procedures or need for retrieval were identified over a median follow-up time of 423.5 (IQR-204-1489) days. Clinicians should be aware of this potential complication, but that retained granulation cuffs appear to offer no sequelae and aggressive interventions for retrieval/removal are likely not warranted.
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9
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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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10
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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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11
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Malignant Pleural Effusion: Diagnosis and Management. Can Respir J 2020; 2020:2950751. [PMID: 33273991 PMCID: PMC7695997 DOI: 10.1155/2020/2950751] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 07/05/2020] [Accepted: 09/11/2020] [Indexed: 12/11/2022] Open
Abstract
Symptomatic malignant pleural effusion is a common clinical problem. This condition is associated with very high mortality, with life expectancy ranging from 3 to 12 months. Studies are contributing evidence on an increasing number of therapeutic options (therapeutic thoracentesis, thoracoscopic pleurodesis or thoracic drainage, indwelling pleural catheter, surgery, or a combination of these therapies). Despite the availability of therapies, the management of malignant pleural effusion is challenging and is mainly focused on the relief of symptoms. The therapy to be administered needs to be designed on a case-by-case basis considering patient's preferences, life expectancy, tumour type, presence of a trapped lung, resources available, and experience of the treating team. At present, the management of malignant pleural effusion has evolved towards less invasive approaches based on ambulatory care. This approach spares the patient the discomfort caused by more invasive interventions and reduces the economic burden of the disease. A review was performed of the diagnosis and the different approaches to the management of malignant pleural effusion, with special emphasis on their indications, usefulness, cost-effectiveness, and complications. Further research is needed to shed light on the current matters of controversy and help establish a standardized, more effective management of this clinical problem.
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12
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Abstract
Malignant pleural effusion frequently complicates both solid and hematologic malignancies and is associated with high morbidity, mortality, and health care costs. Although no pleura-specific therapy is known to impact survival, both pleurodesis and indwelling pleural catheter (IPC) placement can significantly alleviate symptoms and improve quality of life. The optimal choice of therapy in terms of efficacy and particularly cost-effectiveness depends on patient preferences and individual characteristics, including lung expansion and life expectancy. Attempting chemical pleurodesis through an IPC in the outpatient setting appears to be a particularly promising approach in the absence of a nonexpandable lung.
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Affiliation(s)
- Majid Shafiq
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA
| | - David Feller-Kopman
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, 1800 Orleans Street, Suite 7-125, Baltimore, MD 21287, USA.
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13
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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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14
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Messeder SJ, Thomson MC, Hu MK, Chetty M, Currie GP. Indwelling pleural catheters: an overview and real-life experience. QJM 2019; 112:599-604. [PMID: 31120124 DOI: 10.1093/qjmed/hcz116] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Indwelling pleural catheters (IPCs) are most frequently used in those with malignant pleural effusions, although their use is expanding to patients with non-malignant diseases. AIM To provide an overview of IPCs and highlight how, when and why they can be used including our own real-life experience. DESIGN Data were collected retrospectively from a large tertiary centre for all individuals who received an IPC between June 2010 and February 2018 inclusive. The data collected included gender, age, origin of malignancy, number of drains prior to IPC, whether they had received pleurodesis prior to IPC, presence of a trapped lung, date of insertion, documented complications, overall outcome and date of death. RESULTS A total of 68 patients received an IPC, the majority were female (n = 38, 57%) with an overall median age of 68 years (range 40-90 years). The most common site of cancer origin was lung (n = 33, 49%) followed by pleura (n = 10, 15%) and breast (n = 9, 13%). The median survival of all patients was 141 days (IQR 26-181). Sixteen percent (n = 11) of patients underwent a spontaneous pleurodesis resulting in their IPC being removed. Only three individuals had a complication (4.4%). CONCLUSIONS IPC insertion is a safe procedure and represents an exciting and expanding field in the management of pleural disease. Further longitudinal studies are required to fully delineate their place in the management of both malignant and benign effusions.
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Affiliation(s)
- S J Messeder
- From the Chest Clinic C, Aberdeen Royal Infirmary, Foresterhill, Aberdeen, UK
| | - M C Thomson
- From the Chest Clinic C, Aberdeen Royal Infirmary, Foresterhill, Aberdeen, UK
| | - M K Hu
- From the Chest Clinic C, Aberdeen Royal Infirmary, Foresterhill, Aberdeen, UK
| | - M Chetty
- From the Chest Clinic C, Aberdeen Royal Infirmary, Foresterhill, Aberdeen, UK
| | - G P Currie
- From the Chest Clinic C, Aberdeen Royal Infirmary, Foresterhill, Aberdeen, UK
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15
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Meriggi F. Malignant Pleural Effusion: Still a Long Way to Go. Rev Recent Clin Trials 2019; 14:24-30. [PMID: 30514193 DOI: 10.2174/1574887114666181204105208] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 11/26/2018] [Accepted: 11/27/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND Malignant pleural effusion, which is a common clinical problem in patients with cancer, may be due to both primary thoracic tumours or to a metastatic spread in the chest and constitutes the first sign of disease in approximately 10% of patients. Almost all cancers can potentially produce a pleural effusion. The presence of malignant tumour cells in the pleural fluid is generally indicative of advanced disease and is associated with high morbidity and mortality with reduced therapeutic options. Dyspnoea during mild physical activity or at rest is generally the typical sign of restrictive respiratory failure. METHODS This is a systematic review of all the main articles in the English language on the topic of malignant pleural effusion and reported by the Pubmed database from 1959 to 2018. I reviewed the literature and guidelines with the aims to focus on what is known and on future pathways to follow the diagnosis and treatment of malignant pleural effusions. RESULTS The main goal of palliation of a malignant pleural effusion is a quick improvement in dyspnoea, while thoracentesis under ultrasound guidance is the treatment of choice for patients with a limited life expectancy or who are not candidates for more invasive procedures such as drainage using an indwelling small pleural catheter, chemical pleurodesis with sclerosing agents, pleurectomy or pleuro-peritoneal shunt. CONCLUSION Despite progress in therapeutic options, the prognosis remains severe, and the average survival is 4-9 months from the diagnosis of malignant pleural effusion. Moreover, mortality is higher for patients with malignant pleural effusion compared with those with metastatic cancer but no malignant pleural effusion. Therefore, the prognosis of these patients primarily depends on the underlying disease and the extension of a primary tumour. This review focuses on the most relevant updates in the management of malignant pleural effusion.
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Affiliation(s)
- Fausto Meriggi
- Oncology Department - Poliambulanza Foundation, Brescia, Italy
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16
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Syer T, Walker S, Maskell N. The use of indwelling pleural catheters for the treatment of malignant pleural effusions. Expert Rev Respir Med 2019; 13:659-664. [PMID: 31177915 DOI: 10.1080/17476348.2019.1627203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Introduction: The presence of a malignant pleural effusion (MPE) is a marker of advanced disease and associated with a poor prognosis. Patients are in a palliative stage of their disease and often suffer distressing symptoms including breathlessness and pain. Indwelling pleural catheters (IPCs) are effective in managing pleural effusions and allow ambulatory drainage of the pleural space, reducing symptoms associated with effusions and lowering overall hospital stay. The role of IPCs as a first line option in managing MPEs is expanding with a multitude of recent studies into the optimal application of IPCs, necessitating a review of the current literature. Areas covered: This article will provide an overview of IPCs in MPE; how they're inserted, their indications, continuing management, complications and possible future applications. Expert opinion: IPCs should be considered first-line management of MPEs, alongside standard talc pleurodesis. Recognition of the advantages and disadvantages of each approach allows a more informed patient choice. It is recognized that the use of IPCs can provoke pleurodesis, leading to removal of the catheter. For patients in whom prompt removal of the catheter is a priority, then a more aggressive drainage regime or instillation of talc via the IPC is a reasonable option.
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Affiliation(s)
- Tom Syer
- a Academic Respiratory Unit , University of Bristol , Bristol , UK
| | - Steven Walker
- a Academic Respiratory Unit , University of Bristol , Bristol , UK
| | - Nick Maskell
- a Academic Respiratory Unit , University of Bristol , Bristol , UK
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17
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Yagnik L, Shrestha R. Spontaneous fracture of indwelling pleural catheter. Respirol Case Rep 2018; 6:e00365. [PMID: 30237886 PMCID: PMC6138544 DOI: 10.1002/rcr2.365] [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: 05/30/2018] [Revised: 08/07/2018] [Accepted: 08/14/2018] [Indexed: 11/12/2022] Open
Abstract
Indwelling pleural catheters (IPCs) are increasingly used for the management of symptomatic malignant pleural effusion worldwide. IPCs have been documented to reduce the number of hospital bed days in patients with malignant pleural effusion and thus are often used as the preferred mode of management in fit healthy patients with good performance status. Complications related to IPCs, mainly in the form of pleural infection and needle tract metastasis, are well reported in the literature. Similarly, fracture of IPCs is a recognized complication during the process of IPC removal. We report the first ever case of spontaneous fracture of IPC in a patient with Stage IV lung cancer with malignant pleural effusion who was undergoing active chemotherapy and symptomatic management of the pleural effusion with an IPC.
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Affiliation(s)
- Lokesh Yagnik
- Department of Respiratory MedicineFiona Stanley HospitalMurdochWestern AustraliaAustralia
| | - Ranjan Shrestha
- Department of Respiratory MedicineFiona Stanley HospitalMurdochWestern AustraliaAustralia
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18
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Chalhoub M, Saqib A, Castellano M. Indwelling pleural catheters: complications and management strategies. J Thorac Dis 2018; 10:4659-4666. [PMID: 30174919 DOI: 10.21037/jtd.2018.04.160] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Indwelling pleural catheters (IPCs) are increasingly being used for patients with recurrent malignant pleural effusions. They are simple to place and can be done on an outpatient basis under local anesthesia. IPCs uniformly relieve dyspnea and improve quality of life of patients with malignant pleural effusions. In some patients with recurrent non-malignant pleural effusions, IPCs proved to be effective as well. With increasing use of IPCs, physicians and patients are faced with complications related to the presence of an indwelling catheter for extended periods of time. The purpose of this review is to describe the various complications of IPCs and to present the available data on how to best treat and potentially prevent these complications.
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Affiliation(s)
- Michel Chalhoub
- Department of Medicine, Staten Island University Hospital, Staten Island, NY, USA
| | - Amina Saqib
- Department of Medicine, Staten Island University Hospital, Staten Island, NY, USA
| | - Michael Castellano
- Department of Medicine, Staten Island University Hospital, Staten Island, NY, USA
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Porcel JM, Lui MMS, Lerner AD, Davies HE, Feller-Kopman D, Lee YCG. Comparing approaches to the management of malignant pleural effusions. Expert Rev Respir Med 2017; 11:273-284. [PMID: 28271728 DOI: 10.1080/17476348.2017.1300532] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Management of symptomatic malignant pleural effusions is becoming more complex due to the range of treatment options, which include therapeutic thoracenteses, thoracoscopic talc pleurodesis, bedside pleurodesis with talc or other sclerosing agents via small-bore chest catheters, indwelling pleural catheters, surgery, or a combination of some of these procedures. Areas covered: Recent advances for the expanding range of treatment options in malignant pleural effusions are summarized, according to the best available evidence. Expert commentary: Selection of a treatment approach in malignant pleural effusions should take into account patient preferences and performance status, tumor type, predicted prognosis, presence of a non-expandable lung, and local experience or availability. The role of pleurodesis has decreased with the advent of indwelling pleural catheters, which provide a high degree of symptomatic relief on an outpatient basis and, therefore, are being positioned as a first choice therapy in many centers. Talc poudrage pleurodesis should probably be reserved for those situations in which pleural tumor invasion is discovered during diagnostic thoracoscopy. Ongoing randomized controlled trials will offer solid evidence on which of the available palliative approaches should be selected for each particular patient.
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Affiliation(s)
- José M Porcel
- a Pleural Medicine Unit, Department of Internal Medicine , Arnau de Vilanova University Hospital , Lleida , Spain.,b Institute for Biomedical Research Dr Pifarre Foundation, IRBLLEIDA , Lleida , Spain
| | - Macy Mei-Sze Lui
- c Division of Respiratory and Critical Care Medicine, Department of Medicine , Queen Mary Hospital, University of Hong Kong , Hong Kong , China
| | - Andrew D Lerner
- d Section of Interventional Pulmonology, Division of Pulmonary and Critical Care Medicine , Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - Helen E Davies
- e Department of Respiratory Medicine , Cardiff and Vale University Health Board , Cardiff , Wales , UK
| | - David Feller-Kopman
- d Section of Interventional Pulmonology, Division of Pulmonary and Critical Care Medicine , Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - Y C Gary Lee
- f Respiratory Department , Sir Charles Gairdner Hospital , Western Australia , Perth , Australia.,g Respiratory Medicine , Sir Charles Gairdner Hospital , Perth , Western Australia , Australia.,h Pleural Medicine Unit , Institute of Respiratory Health , Western Australia , Perth , Australia.,i Centre for Respiratory Health, School of Medicine , University of Western Australia , Perth , Australia
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Abstract
Malignant pleural effusion (MPE) is common in clinical practice, and despite the existence of studies to guide clinical decisions, it often poses diagnostic and therapeutic dilemmas. Once it is diagnosed, median survival does not usually exceed 6 months. The management of these patients focuses on symptom relief since no treatments have been shown to increase survival to date. Conversely, poor management can shorten survival. The approach must be multidisciplinary and allow for individualized care. Initial diagnostic procedures should be minimally invasive and, according to the results and other factors, procedures of increasing complexity will be selecting. Likewise, the treatment of MPEs should be individualized according to factors such as type of tumor, patient functional status, means available, benefits of each procedure, or life expectancy. Currently, treatment seems to tend toward less interventional approaches, in which patients can be managed on an outpatient basis, thus minimizing both the discomfort that more aggressive approaches involve and the costs of care associated with this disease. This article reviews the pleural procedures employed in the management of MPEs with special emphasis on the indication for each one, its usefulness, benefits, and complications.
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Affiliation(s)
- Lucía Ferreiro
- Department of Pulmonology, University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain; Interdisciplinary Research Group in Pulmonology, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Juan Suárez-Antelo
- Department of Pulmonology, University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - Luis Valdés
- Department of Pulmonology, University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain; Interdisciplinary Research Group in Pulmonology, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
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21
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Lui MMS, Thomas R, Lee YCG. Complications of indwelling pleural catheter use and their management. BMJ Open Respir Res 2016; 3:e000123. [PMID: 26870384 PMCID: PMC4746457 DOI: 10.1136/bmjresp-2015-000123] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 01/05/2016] [Indexed: 11/23/2022] Open
Abstract
The growing utilisation of indwelling pleural catheters (IPCs) has put forward a new era in the management of recurrent symptomatic pleural effusions. IPC use is safe compared to talc pleurodesis, though complications can occur. Pleural infection affects <5% of patients, and is usually responsive to antibiotic treatment without requiring catheter removal or surgery. Pleural loculations develop over time, limiting drainage in 10% of patients, which can be improved with intrapleural fibrinolytic therapy. Catheter tract metastasis can occur with most tumours but is more common in mesothelioma. The metastases usually respond to analgaesics and/or external radiotherapy. Long-term intermittent drainage of exudative effusions or chylothorax can potentially lead to loss of nutrients, though no data exist on any clinical impact. Fibrin clots within the catheter lumen can result in blockage. Chest pain following IPC insertion is often mild, and adjustments in analgaesics and drainage practice are usually all that are required. As clinical experience with the use of IPC accumulates, the profile and natural course of complications are increasingly described. We aim to summarise the available literature on IPC-related complications and the evidence to support specific strategies.
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Affiliation(s)
- Macy M S Lui
- Division of Respiratory and Critical Care Medicine, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong; Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Rajesh Thomas
- Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia; Pleural Medicine Unit, Institute of Respiratory Health, Perth, Western Australia, Australia; Centre for Respiratory Health, School of Medicine & Pharmacology, University of Western Australia, Perth, Western Australia, Australia
| | - Y C Gary Lee
- Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia; Pleural Medicine Unit, Institute of Respiratory Health, Perth, Western Australia, Australia; Centre for Respiratory Health, School of Medicine & Pharmacology, University of Western Australia, Perth, Western Australia, Australia
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22
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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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Sweatt AJ, Sung A. Interventional pulmonologist perspective: treatment of malignant pleural effusion. Curr Treat Options Oncol 2015; 15:625-43. [PMID: 25240411 DOI: 10.1007/s11864-014-0312-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OPINION STATEMENT The management of known malignant pleural effusions focuses around the initial thoracentesis and subsequent objective and subjective findings. A completely reexpanded lung after fluid removal and with symptomatic improvement predicts successful pleurodesis. Pleurodesis method depends on center expertise as well as patient preference. Medical thoracoscopy does not require the operating room setting and is performed on the spontaneously breathing patient with similar success rate to surgical thoracoscopy in the appropriately selected patients. However, it is not widely available. Talc insufflation is preferred for even distribution of sprayed particles to pleural surfaces. Most often, patients can be discharged home within 24 to 48 hours after continuous chest tube suction. Indwelling pleural catheter has become popular given the ease of insertion and patient centered home drainage. Coordinated care with good patient and family education and support is paramount to maximizing the beneficial potential of the catheter. Complications are minimal, and catheters are easily removed if patients can no longer benefit from drainage, or if pleurodesis has occurred. In the setting of trapped lung as a result of visceral pleura encasement from tumor, indwelling catheter can still be useful if the patient improves with thoracentesis. However, if no subjective improvement is seen after thoracentesis for trapped lung, then no procedure is recommended and other modes of palliation should be sought.
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Affiliation(s)
- Andrew J Sweatt
- Division of Pulmonary and Critical Care Medicine, Stanford University, Stanford, CA, USA,
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24
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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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26
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Bhatnagar R, Maskell NA. Indwelling pleural catheters. Respiration 2014; 88:74-85. [PMID: 24853298 DOI: 10.1159/000360769] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Accepted: 02/11/2014] [Indexed: 01/02/2023] Open
Abstract
Indwelling pleural catheters (IPC) are now established as one of the major tools for the management of recurrent pleural effusions. Their traditional role, which saw them only as second line treatment for malignant effusions, has now expanded. Recent evidence has not only suggested that they may be effectively employed as first-line therapy in some malignant cases, but that there is a wider spectrum of diseases which may be managed by their use. The majority of patients are likely to experience symptomatic benefit and some may also go on to achieve pleurodesis. IPCs are relatively simple to insert and maintain, and theoretically allow patients to be managed entirely as an outpatient, meaning that they are likely to be cost-effective in the longer term. They can also dramatically improve the quality of life in patients who have typically needed lengthy hospital admissions or who have terminal malignant disease.
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Affiliation(s)
- Rahul Bhatnagar
- Academic Respiratory Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
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27
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Fysh ETH, Tremblay A, Feller-Kopman D, Mishra EK, Slade M, Garske L, Clive AO, Lamb C, Boshuizen R, Ng BJ, Rosenstengel AW, Yarmus L, Rahman NM, Maskell NA, Lee YCG. Clinical outcomes of indwelling pleural catheter-related pleural infections: an international multicenter study. Chest 2014; 144:1597-1602. [PMID: 23828305 DOI: 10.1378/chest.12-3103] [Citation(s) in RCA: 122] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Indwelling pleural catheters (IPCs) offer effective control of malignant pleural effusions (MPEs). IPC-related infection is uncommon but remains a major concern. Individual IPC centers see few infections, and previous reports lack sufficient numbers and detail. This study combined the experience of 11 centers from North America, Europe, and Australia to describe the incidence, microbiology, management, and clinical outcomes of IPC-related pleural infection. METHODS This was a multicenter retrospective review of 1,021 patients with IPCs. All had confirmed MPE. RESULTS Only 50 patients (4.9%) developed an IPC-related pleural infection; most (94%) were successfully controlled with antibiotics (62% IV). One death (2%) directly resulted from the infection, whereas two patients (4%) had ongoing infectious symptoms when they died of cancer progression. Staphylococcus aureus was the causative organism in 48% of cases. Infections from gram-negative organisms were associated with an increased need for continuous antibiotics or death (60% vs 15% in gram-positive and 25% mixed infections, P = .02). The infections in the majority (54%) of cases were managed successfully without removing the IPC. Postinfection pleurodesis developed in 31 patients (62%), especially those infected with staphylococci (79% vs 45% with nonstaphylococcal infections, P = .04). CONCLUSIONS The incidence of IPC-related pleural infection was low. The overall mortality risk from pleural infection in patients treated with IPC was only 0.29%. Antibiotics should cover S aureus and gram-negative organisms until microbiology is confirmed. Postinfection pleurodesis is common and often allows removal of IPC. Heterogeneity in management is common, and future studies to define the optimal treatment strategies are needed.
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Affiliation(s)
- Edward T H Fysh
- Pleural Diseases Unit, Sir Charles Gairdner Hospital, Perth, WA, Australia; Centre for Asthma, Allergy, and Respiratory Research, and the School of Medicine and Pharmacology, University of Western Australia, Perth, WA, Australia
| | - Alain Tremblay
- Division of Respiratory Medicine, University of Calgary, Calgary, AB, Canada
| | - David Feller-Kopman
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins Hospital, Baltimore, MD
| | - Eleanor K Mishra
- Oxford Respiratory Trials Unit, Churchill Hospital, Oxford, England
| | - Mark Slade
- Department of Thoracic Oncology, Papworth Hospital, Cambridge, England
| | - Luke Garske
- Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Amelia O Clive
- Academic Respiratory Unit, School of Clinical Sciences, University of Bristol, Bristol, England
| | | | | | - Benjamin J Ng
- Nepean Hospital Lung Cancer Multidisciplinary Group, Sydney, NSW, Australia
| | | | - Lonny Yarmus
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins Hospital, Baltimore, MD
| | - Najib M Rahman
- Oxford Respiratory Trials Unit, Churchill Hospital, Oxford, England
| | - Nick A Maskell
- Academic Respiratory Unit, School of Clinical Sciences, University of Bristol, Bristol, England
| | - Y C Gary Lee
- Pleural Diseases Unit, Sir Charles Gairdner Hospital, Perth, WA, Australia; Centre for Asthma, Allergy, and Respiratory Research, and the School of Medicine and Pharmacology, University of Western Australia, Perth, WA, Australia.
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Ried M, Hofmann HS. The treatment of pleural carcinosis with malignant pleural effusion. DEUTSCHES ARZTEBLATT INTERNATIONAL 2013; 110:313-8. [PMID: 23720697 DOI: 10.3238/arztebl.2013.0313] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Pleural carcinosis is caused by tumors of the chest (e.g., lung and breast cancer) or elsewhere in the body (e.g., ovarian carcinoma) that metastasize to the visceral and/or parietal pleura. Recurrent malignant pleural effusion due to pleural carcinosis is one of the most common findings in oncology. It affects about 56 000 patients per year in Germany alone. METHODS This review is based on pertinent literature retrieved by a selective search of the Medline database (key words: malignant pleural effusion, pleural carcinosis) and on the authors' clinical experience. RESULTS Although many retrospective studies have been published, there has been only one randomized controlled trial of treatment, in which permanent pleural catheters were compared with talcum pleurodesis. Patients with pleural carcinosis have a median survival of less than 12 months. Many are suffering from progression of their underlying disease, with generalized tumor involvement; thus, the symptomatic treatment of pain and dyspnea is often the main therapeutic issue. The underlying tumor, usually an adenocarcinoma, can be diagnosed either by histology or by cytology. The main complication is progressive respiratory failure. The treatment is palliative, rather than curative. The main approaches are drainage of the effusion (by thoracocentesis or with permanent pleural catheters) and pleurodesis (obliteration of the pleural space by causing the visceral and parietal pleura to adhere to each other). CONCLUSION Pleural carcinosis with symptomatic malignant pleural effusion is treated palliatively. The appropriate treatment in each case should be determined through discussion with the patient, with the goal of improving the patient's quality of life.
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Affiliation(s)
- Michael Ried
- Department of Thoracic Surgery, University Hospital Regensburg, Regensburg, Germany.
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Navarro-Mingorance A, Reyes-Dominguez SB, León-León MC, Pastor-Vivero MD. [Pleural catheter rupture: a report of 2 cases]. An Pediatr (Barc) 2013; 80:125-6. [PMID: 23726684 DOI: 10.1016/j.anpedi.2013.02.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2012] [Revised: 02/21/2013] [Accepted: 02/24/2013] [Indexed: 11/17/2022] Open
Affiliation(s)
- A Navarro-Mingorance
- Sección de Cuidados Intensivos Pediátricos, Hospital Universitario Virgen de la Arrixaca, Murcia, España.
| | - S B Reyes-Dominguez
- Sección de Cuidados Intensivos Pediátricos, Hospital Universitario Virgen de la Arrixaca, Murcia, España
| | - M C León-León
- Sección de Cuidados Intensivos Pediátricos, Hospital Universitario Virgen de la Arrixaca, Murcia, España
| | - M D Pastor-Vivero
- Sección de Neumología Pediátrica, Hospital Universitario Virgen de la Arrixaca, Murcia, España
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Abstract
The treatment of chronic recurrent pleural effusions continues to evolve with the recent emergence of tunneled indwelling pleural catheters (IPCs). Talc pleurodesis has been the standard of care for treatment of recurrent pleural effusions, but IPCs have gained more favor in recent years. IPCs offer several advantages, including a less invasive procedure, short postprocedure hospital stay, and greater patient control in the management of symptoms. Further randomized controlled studies are needed to more clearly differentiate which patients are better served by an IPC rather than traditional pleurodesis as their initial intervention.
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Affiliation(s)
- Jacob Gillen
- Department of Surgery, University of Virginia Health System, 725-2B Walker Square, Charlottesville, VA 22903, USA
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31
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Abstract
Tunneled pleural catheters (TPCs) are a safe, effective, and well-tolerated option for palliation in patients with malignant pleural effusion (MPEs) on an outpatient basis. TPCs are incorporated into international guidelines for the management of MPEs and appear to be the most cost-effective option according to current data.
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32
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Advantages of indwelling pleural catheters for management of malignant pleural effusions. ACTA ACUST UNITED AC 2013. [DOI: 10.1007/s13665-013-0042-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Grosu HB, Eapen GA, Morice RC, Ost D, Bashoura L, Faiz S, Jimenez CA. Complications of removal of indwelling pleural catheters. Chest 2012; 142:1071. [PMID: 23032463 DOI: 10.1378/chest.12-1078] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Horiana B Grosu
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Georgie A Eapen
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Rodolfo C Morice
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - David Ost
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Lara Bashoura
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Saadia Faiz
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Carlos A Jimenez
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX.
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35
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Fysh ET, Wrightson JM, Lee YG, Rahman NM. Complications of Removal of Indwelling Pleural Catheters: Response. Chest 2012. [DOI: 10.1378/chest.12-1357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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