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Original Research |

Indwelling Pleural Catheters Reduce Inpatient Days Over Pleurodesis for Malignant Pleural EffusionIndwelling Pleural Cathether

Edward T. H. Fysh, MBBS; Grant W. Waterer, PhD; Peter A. Kendall, MBBS; Peter R. Bremner, MBChB; Sharifa Dina, RN; Elizabeth Geelhoed, PhD; Kate McCarney, RN; Sue Morey, NP; Michael Millward, MA; A. W. (Bill) Musk, MD, FCCP; Y. C. Gary Lee, PhD, FCCP
Author and Funding Information

From the Department of Respiratory Medicine (Drs Fysh, Musk, and Lee and Mss McCarney and Morey), and the Department of Medical Oncology (Mr Millward), Sir Charles Gairdner Hospital, Perth; the Centre for Asthma, Allergy, and Respiratory Research (Drs Fysh and Lee), the School of Medicine and Pharmacology (Drs Fysh, Waterer, Kendall, and Lee and Mr Millward), and the School of Population Health (Drs Geelhoed and Musk), University of Western Australia, Perth; the Department of Respiratory Medicine (Dr Waterer), Royal Perth Hospital, Perth; and the Department of Respiratory Medicine (Drs Kendall and Bremner and Ms Dina), Fremantle Hospital, Fremantle, WA, Australia.

Correspondence to: Y. C. Gary Lee, PhD, FCCP, University Department of Medicine, QE II Medical Centre, Perth, WA 6009, Australia; e-mail: gary.lee@uwa.edu.au


Funding/Support: This project was funded by a grant from the State Health Research Advisory Council of the Western Australian Health Department and from the Sir Charles Gairdner Research Foundation. Dr Fysh receives scholarships from the National Health and Medical Research Council and the Lung Institute of Western Australia.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2012;142(2):394-400. doi:10.1378/chest.11-2657
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Background:  Patients with malignant pleural effusion (MPE) have limited prognoses. They require long-lasting symptom relief with minimal hospitalization. Indwelling pleural catheters (IPCs) and talc pleurodesis are approved treatments for MPE. Establishing the implications of IPC and talc pleurodesis on subsequent hospital stay will influence patient choice of treatment. Therefore, our objective was to compare patients with MPE treated with IPC vs pleurodesis in terms of hospital bed days (from procedure to death or end of follow-up) and safety.

Methods:  In this prospective, 12-month, multicenter study, patients with MPE were treated with IPC or talc pleurodesis, based on patient choice. Key end points were hospital bed days from procedure to death (total and effusion-related). Complications, including infection and protein depletion, were monitored longitudinally.

Results:  One hundred sixty patients with MPE were recruited, and 65 required definitive fluid control; 34 chose IPCs and 31 pleurodesis. Total hospital bed days (from any causes) were significantly fewer in patients with IPCs (median, 6.5 days; interquartile range [IQR] = 3.75-13.0 vs pleurodesis, mean, 18.0; IQR, 8.0-26.0; P = .002). Effusion-related hospital bed days were significantly fewer with IPCs (median, 3.0 days; IQR, 1.8-8.3 vs pleurodesis, median, 10.0 days; IQR, 6.0-18.0; P < .001). Patients with IPCs spent significantly fewer of their remaining days of life in hospital (8.0% vs 11.2%, P < .001, χ2 = 28.25). Fewer patients with IPCs required further pleural procedures (13.5% vs 32.3% in pleurodesis group). There was no difference in rates of pleural infection (P = .68) and protein (P = .65) or albumin loss (P = .22). More patients treated with IPC reported immediate (within 7 days) improvements in quality of life and dyspnea.

Conclusions:  Patients treated with IPCs required significantly fewer days in hospital and fewer additional pleural procedures than those who received pleurodesis. Safety profiles and symptom control were comparable.

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