PURPOSE: The use of tunneled indwelling pleural catheters (TIPCs) in non-malignant disease has not been systematically investigated. We characterize our experience with the use of TIPCs in non-malignant pleural effusions.
METHODS: Retrospective review of the use of TIPCs in non-malignant pleural effusions at Mayo Clinic, Rochester, Minnesota between 2006-2010. Student’s t-test for continuous, and Chi-square analysis for categorical variables are used.
RESULTS: One-hundred and nine TIPCs were placed for non-malignant effusions (28% or all TIPCs placed). Forty-four (40%) were placed for heart failure, 26 (24%) for inflammatory pleuritis, 10 (9%) for chylothoraces, 6 (5%) for renal failure, 5 (5%) each for hepatic hydrothoraces and trapped lung, and 13 (12%) for other etiologies. In total, 60 (55%) were placed for transudative, and 49 (45%) for exudative processes. All but 4 patients (96%) reported symptom improvement with TIPC use. Hospitalization from pleural disease one year after TIPC placement was reduced when compared to one year prior for all types of effusions (0.4 vs 1.6 admissions, p<0.0001), with the largest reduction seen in heart failure (0.5 vs 2.4 admissions, p<0.0001). Sixty-nine (63%) catheters were removed at a median duration of 89 days, while 32 (30%) remained in place until patient death, and 8 (7%) remaining in place with the patient currently living. Sixty-four (59%) catheters were removed at a median of 90 days due to spontaneous pleurodesis, and there was no difference in pleurodesis time between exudative and transudative processes (89 vs 95 days, p=0.71). Complications included empyema in 5 (5%), reversible tube occlusion in 4 (4%), pneumothorax, catheter leakage, and post-insertion pain each in 2 (2%), and tube malposition and tunnel-track infection each in 1 (1%). Pneumothorax was the only procedural complication.
CONCLUSIONS: TIPCs appear useful in the management of non-malignant pleural effusions. Symptom control, complications, and rate of spontaneous pleurodesis appear similar to those reported for their use in malignant pleural disease.
CLINICAL IMPLICATIONS: TIPCs may be a viable option for management of symptomatic, recurrent non-malignant pleural effusions.
DISCLOSURE: The following authors have nothing to disclose: John Mullon, Fabien Maldonado
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