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Original Research |

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

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.

Figures in this Article

Malignant pleural effusion (MPE) affects 660 patients per million population each year.1 The resultant breathlessness is often disabling and impairs quality of life (QoL). Pleurodesis, the conventional management for MPEs, requires either lengthy hospital admission and/or considerable surgical resources. It is not suitable for patients with trapped lung wherein the visceral and parietal pleural layers are apart and not able to be fused.24 Even in selected patients, the largest clinical trial of talc pleurodesis had a success rate of about 75% at 1 month and < 50% by 6 months as well as considerable complications.5

Indwelling pleural catheters (IPCs) are an increasingly popular alternative to pleurodesis. More than 39,000 units are sold in the United States each year for management of pleural or peritoneal effusions.6 IPCs can be inserted as an outpatient procedure and offer rapid relief of dyspnea through ambulatory drainage of effusions.7,8 This avoids admission to hospital associated with pleurodesis and the potential side effects from pleurodesing agents.913

Previous studies have shown the clinical usefulness of IPCs predominantly for patients in whom pleurodesis has failed or is contraindicated (most commonly because of trapped lung). The use of IPC as first-line treatment of MPE remains controversial, and concerns about complications (eg, infection and protein depletion) deter its use. Studies directly comparing first-line therapy with IPCs and talc pleurodesis in a pragmatic setting based on patient/clinician choice are lacking.

The State Health Research Advisory Council study of the Western Australian Health Department was a pilot, prospective, observational study comparing IPC vs pleurodesis in patients with an MPE. The study was nonrandomized but governed by the choice of patients and their attending clinicians. The hypotheses were that (1) patients treated with IPC would spend fewer days in hospital and (2) use of IPCs was safe. The key end point was the number of hospital bed days due to admissions of any cause. Other end points included hospital bed days due to pleural effusion-related admissions, QoL, and symptom measures and major complications.

This study forms part of the analyses of the Western Australian study of Malignant Pleural Effusion, approved by the Human Research Ethics Committees of the Sir Charles Gairdner, Fremantle, and Royal Perth Hospitals in Western Australia, and the University of Western Australia (approval number 2009-104). All patients provided written, informed consent.

Patients with MPE from the three major public teaching hospitals in Perth, Western Australia (population about 1.7 million) were recruited over 12 months from October 1, 2009, and followed up December 31, 2010, or death. The diagnosis of MPE was confirmed histocytologically. Patients’ demographic, clinical, radiologic, biochemical (blood and pleural fluid), and histologic information were recorded and followed up longitudinally.

All patients who warranted definitive treatment (by IPC or pleurodesis) had histocytologically confirmed pleural malignancies and demonstrated symptomatic improvement with fluid drainage. No consensus exists for the use of IPC or pleurodesis as first-line therapy for MPE. A realistic, patient-centered approach was, therefore, taken, whereby the choice between IPC and pleurodesis was made by patients and their attending clinicians. The pros and cons of each modality of treatment were discussed with the patient, as per our published reviews.13,14 Pleurodesis and IPC were both offered to patients provided there were no contraindications, which included short predicted survival (either treatment), trapped lung (for pleurodesis), or inability to manage the device (for IPC). In the absence of effective means to predict survival, the subjective assessments of prognosis by the treating physicians were used. These were based on performance status and other clinical factors.15 Pleurodesis or IPC therapy was only undertaken if the clinician felt the treatment was likely to save the patient three or more drainage procedures in the patient’s remaining life span. As trapped lung was regarded as a contraindication to pleurodesis, the IPC group predictably had a higher proportion of these patients (Table 1).

Table Graphic Jump Location
Table 1 —Patient Characteristics

Data are presented as No. or No. (%) unless otherwise noted. No difference was found between the groups in their baseline demographic data, except for trapped lung, as expected. IPC = indwelling pleural catheter; IQR = interquartile range.

Indwelling Pleural Catheter

IPCs (Rocket Medical) were inserted with imaging guidance, usually as a day-case. Patients were reviewed within 10 days after insertion to assess healing, then fortnightly for the first month and monthly thereafter. Additional visits were arranged if clinically indicated. Patients were advised to perform drainage when symptomatic. Patients with IPCs could receive other therapies (including chemotherapy) as clinically appropriate. Removal of the IPC was considered if no fluid could be drained for > 1 month or if the patient no longer derived symptomatic benefit from catheter drainage.

Blood and pleural fluid samples were taken at the monthly review or more frequently if indicated. Complete blood picture, electrolytes, liver function tests, and C-reactive protein level were measured from peripheral blood. Pleural fluid was assessed for pH, protein, lactate dehydrogenase, and glucose and subjected to bacterial culture. Empyema was defined as positive pleural fluid cultures or presence of pus with systemic signs of infection. No patients received prophylactic radiotherapy to pleural puncture sites.

Pleurodesis

Pleurodesis was performed using graded talc (Novatech) either as bedside talc slurry or thoracoscopic poudrage, as preferred by the clinician in charge, since randomized studies showed no superiority of either method.5,16 All pleurodesis procedures were performed in hospital. Generally, small-bore (12F-15F) tubes inserted by Seldinger technique were used for bedside pleurodesis, whereas large-bore (24F-32F) tubes were placed after thoracoscopy. Timing of talc insertion and chest tube removal were decided by the treating physicians according to local protocols. In general, talc slurry was administered when the lung was fully re-expanded and drainage volume reduced. In the absence of any other reasons for inpatient care, patients were discharged as soon as a satisfactory postremoval chest radiograph was obtained. Failure of pleurodesis was defined as the need for another ipsilateral pleural procedure at any time.

Determining Length of Hospital Stay and Relation to the Pleural Effusion

Hospital admissions from any cause were recorded, using a statewide clinical data program available in all recruiting hospitals and using discharge summary data from private hospital admissions. Day case interventional procedures (including IPC insertion) counted as 1 day in hospital. Counts of hospital bed days incurred during the pleurodesis procedure started from time of insertion of chest tube or thoracoscopy. Presentations to day-stay chemotherapy units for drug infusion were not included as hospital admissions.

Admissions were classified as related or unrelated to the pleural effusion. For admissions up to and including 7 days, the entire admission was judged as effusion-related if a pleural procedure was performed, or a radiologic investigation showed the presence or recurrence of the effusion being studied, or a complication of a prior pleural procedure was found or treated. If none of the criteria explained here was met, the admission was labeled “unrelated to pleural effusion.” For admissions > 7 days, a week-by-week assessment using the same rules was performed. Weeks that did not include a pleural procedure or radiologic test showing an effusion were “unrelated.”

Short-term QoL and Symptom Scores

Patients recorded their QoL and dyspnea on a visual analog scale (100 mm) immediately before and daily for 1 week after any pleural procedure as validated.17,18 The minimally important difference (MID) is defined as one-half SD of the baseline.19 The patient improved if at least one postprocedure score was > 1 MID above his/her own baseline, and if no other postprocedure score fell below the baseline. Deterioration refers to a drop of any score by > 1 MID below the patient’s baseline, regardless of his/her other daily scores.

Statistics

Data were analyzed on an intention-to-treat basis. Intergroup comparisons were performed, where appropriate, by the χ2, Fisher exact, Student t test, and Mann-Whitney rank-sum tests using SigmaPlot (version 12, Sysstat Software). Significance was defined as P < .05.

Baseline Demographics

Of the 160 patients with MPE enrolled, 65 had symptomatic and, in most cases, recurrent effusions that required definitive treatment. Thirty-four patients elected to be treated with an IPC and 31 with talc pleurodesis. The two groups were similar in their baseline characteristics (Table 1).

IPCs were inserted by the respiratory (n = 30), radiology (n = 3), and cardiothoracic (n = 1) services. As expected, more patients in the IPC group had incomplete lung re-expansion after initial drainage, suggesting trapped lung (16 of 34 as opposed to one of 31 in the pleurodesis group). The median time IPCs remained in situ was 53.5 days (interquartile range [IQR], 24-116; range, 1-350). All patients with IPC except one were followed up at a central service based at Sir Charles Gairdner Hospital, supervised by two investigators (E. T. H. F. and Y. C. G. L.). The median follow-up time in the IPC and pleurodesis groups were 93 days (IQR, 28-172) and 134 days (IQR, 51-215), respectively (P = .18). Fourteen patients (41.2%) who were treated with IPC developed spontaneous pleurodesis after 80.5 days (median; IQR, 55-104) permitting catheter removal. This included four of the 16 patients (25%) whose lung did not re-expand fully after initial drainage.

Pleurodeses were performed as talc slurry (n = 24), pleuroscopic poudrage (n = 1), or video-assisted thoracoscopic surgery (n = 6). Three patients in the pleurodesis group subsequently required an IPC due to fluid reaccumulation. One patient treated with an IPC later underwent pleurectomy.

Chief End Point
Days in Hospital:

Patients treated with IPC spent significantly fewer days in hospital (median, 6.5 days; IQR, 3.75-13.0) compared with those who chose pleurodesis (median, 18.0 days; IQR, 8.0-26.0) (P = .002) (Fig 1). The benefits were consistent both in patients with metastatic malignancy (IPC, 5.5 days [median; IQR, 3.0-12.0] vs pleurodesis 18.0 days [IQR, 8.0-32.0], P = .012) and those with mesothelioma (IPC, 9.0 days [IQR, 5.0-13.0] vs pleurodesis 15.5 days [IQR, 8.5-22.0], P = .06).

Figure Jump LinkFigure 1. Total number of days in hospital throughout the follow-up period from any cause of admission. Patients treated with IPCs spent significantly fewer days in hospital. IPC = indwelling pleural catheter; IQR = interquartile range.Grahic Jump Location

The differences in pleural effusion-related hospital bed days were even more pronounced: IPC group median 3.0 days (IQR, 1.75-8.25) vs pleurodesis group 10.0 days (IQR 6.0-18.0), P < .001 (Fig 2). There was no significant difference in the number of episodes of hospital admissions (1) from any cause between the IPC and pleurodesis groups: median 2 (IQR, 1.0-3.0) vs 2 (IQR, 1.0-4.0), respectively; or (2) from effusion-related admissions: 1 (IQR, 1.0-2.0) and 1 (IQR, 1.0-3.0) respectively.

Figure Jump LinkFigure 2. Total number of days in hospital related to the effusion. See Figure 1 legend for expansion of abbreviations.Grahic Jump Location

To adjust for shorter follow-up times in the IPC group, the total number of hospital bed days were compared as a proportion of the total follow-up time for each group. The IPC group incurred 341 hospital bed days out of 4,282 days of follow-up (8.0%) as opposed to 600 out of 5,347 days in the pleurodesis group (11.2%) (χ2 = 28.3; degrees of freedom, 1; P < .001).

Other End Points
Control of Effusion:

IPC offered effective fluid control in most patients (86.5%) compared with pleurodesis (67.7%), P = .12. Failure of pleurodesis requiring subsequent drainage procedures occurred in 10 patients (32.3%) after a median time of 51.5 days (IQR, 22-116). Failure of IPC drainage from symptomatic loculation occurred in five patients (13.5%). All were treated with intrapleural fibrinolytic therapy (n = 2 urokinase, n = 3 with tissue plasminogen activator) via the IPC, with success (improvement of symptoms and effusion size radiographically) in four patients, although symptomatic loculations recurred in three.

Short-term QoL and Dyspnea:

More patients treated with IPCs reported improved QoL scores (P = .02). Fourteen patients (93.3%) in the IPC group recorded a significant improvement in QoL, one (6.7%) reported no change, and none (0%) deteriorated (vs 50.0%, 41.7%, and 8.3%, respectively, in the pleurodesis group). Likewise, more patients in the IPC group recorded an improvement in dyspnea than in the pleurodesis group (93.3% vs 78.6%, respectively), although this did not reach statistical significance (Table 2). The MID for QoL was 12.9 and 10.4 and for dyspnea 9.6 and 10.3 for the IPC and pleurodesis groups, respectively, and comparable to other studies using the same instruments.1618

Table Graphic Jump Location
Table 2 —Short-term QoL and Dyspnea Scores

Data are presented as No. (%). The QoL and dyspnea scores were recorded immediately before and daily for the first 7 days after IPC insertion or pleurodesis. Complete QoL assessments were received from 15 of 34 (44.1%) and 12 of 31 (38.7%) patients of the IPC and pleurodesis groups, respectively, and completed dyspnea assessments from 15 of 34 (44.1%) and 14 of 31 (45.2%), respectively. QoL = quality of life. See Table 1 legend for expansion of other abbreviation.

Safety:

Both procedures were relatively safe (Table 3). One death was directly related to video-assisted thoracoscopic surgery pleurodesis due to postoperative recurrent bleeding and sepsis.

Table Graphic Jump Location
Table 3 —Complication Rates During Study Period (Minimum 3 mo)

Data are presented as No. (%). See Table 1 legend for expansion of abbreviation.

The incidence of empyema was comparable in both groups (10.8% IPC, 6.4% pleurodesis group, P = .68). All empyemas associated with IPC were successfully treated with drainage via the catheter and antibiotics. None required early removal of the catheter. Two patients spontaneously pleurodesed and the catheters were removed after resolution of the infection.

No significant albumin or protein depletion was seen in either group from initiation of therapy to death or 3-month follow-up; the median change in serum albumin level was −1.0 g/L (IQR, −4.5 to 1.5) in the IPC group and +1.0 g/L (IQR, −3.0 to 6.0; P = .22) in the pleurodesis group. Median protein changes were −1.7 g/L (IQR, −6.5 to 1.0) and +3.5 g/L (IQR, −10.5 to 8.0; P = .65), respectively (Fig 3). Mean serum albumin levels at death or 3 months were 37.2 (5.6) g/L in the IPC group and 37.8 (5.4) g/L in the pleurodesis group (P = .73), and mean protein levels at this time were 69.5 (7.0) and 70.1 (8.6) g/L, respectively (P = .81).

Figure Jump LinkFigure 3. Median change in serum albumin and protein from initiation of therapy to death or 3-month follow-up. No significant depletion was seen in either group. Pleuro = pleurodesis. See Figure 1 legend for expansion of other abbreviations.Grahic Jump Location

This study confirmed in a prospective, pragmatic, patient-choice setting that the use of IPC significantly reduced the number of hospital bed days for patients with an MPE that required definitive treatment. The nonrandomized, patient-centered design whereby patients and clinicians were allowed to tailor therapy to individual circumstances replicated real-life settings. A median reduction of 11.5 hospital bed days is significant for these patients with limited life spans and can represent substantial health-care savings. The use of IPC also helped avoid further invasive pleural drainage procedures compared with pleurodesis. In this study, IPC had a comparable safety profile and provided equivalent, if not superior, symptom control compared with talc pleurodesis.

MPE can complicate most cancers, and its incidence is rising. Patients with MPE have a median survival of about 3 to 4 months for metastatic pleural disease19,20 and about 9 to 12 months for mesothelioma.21,22 The key aims of management are to provide ambulatory symptom relief without necessitating hospitalization.23

Patients who chose IPC spent 64% less time, or 11.5 (median) fewer days in hospital beds than those who underwent pleurodesis. It would appear that these findings are consistent for both metastatic malignancies and for mesothelioma, although in the latter group the results fell just short of statistical significance. Conventional therapy with pleurodesis requires admission of 4 to 8 days in most published studies, including a randomized trial of an accelerated discharge protocol,24 and in our local data (6.5 days, Western Australia Health Department). In the largest randomized study of talc pleurodesis, the success rate was only about 75% at 1 month, but the failure rate rose to 50% in patients who survived 6 months.5 Our data echoed these findings and found that 32% of pleurodesis patients needed further fluid drainage before death. In comparison, 86% of the patients treated with IPC avoided further invasive drainage, and spontaneous pleurodesis developed in 41% after a median time of 80.5 days, an increasingly reported benefit.8,13 The additional drainage procedures in the pleurodesis group contributed to the significant differences in hospital bed days seen in our study.

The reduction in hospital bed days was for admissions from any cause—a robust measure that is meaningful to patients and health-care providers. There was no difference in the number of admissions to hospital between the groups, suggesting that therapy with an IPC is more effective at reducing the length of the admissions both at initiation of therapy and at readmission.

The management of MPE represents an increasing health-care expenditure. In Western Australia, the inpatient care cost for MPE management doubled between 2003 and 2008 ($5.4 to $11.7 million) and the number of hospital admissions rose from 1,522 to 2,293 per year. Although further analysis is needed to include costs attributable to the increase in outpatient visits incurred by the IPC group, the annual inpatient health-care savings of IPC implicated from our study would exceed $8.4 million per million population (based on 660 patients/million population, a difference in mean bed days of 9.4 and $1,353/d of inpatient cost), if the findings are extrapolated to all patients with MPE.

The uptake of IPC use has been variable worldwide, in part due to the paucity of direct comparisons of its safety with talc pleurodesis. Our study adds support to recent reports25,26 that complication rates were comparable, if not in favor of IPC management. Complications in this study (as found previously) were generally mild and easily manageable. A significantly higher proportion of this IPC group reported an improvement in QoL, and there were trends toward better dyspnea relief. These findings may be explained in part by the pain and fever from talc pleurodesis and the fact that these patients stayed in hospital with a chest tube in situ for several days.

Common concerns of IPC-related infection and protein depletion did not appear to be a major issue in our study. No significant difference in infection risks was observed, and IPC-related empyema responded promptly to antibiotics with no significant long-term sequelae and did not necessitate IPC removal. We also found no significant protein depletion despite frequent effusion drainage via IPC.

There are several limitations to this study. First, it was designed to mimic real-life practice, in which no data exist that define whether IPC or pleurodesis should be the preferred therapy. Patients were not randomized but were allowed to choose, in consultation with the attending physician, between IPC and pleurodesis. Although not randomized, the baseline characteristics of the two groups of patients were similar (Table 1). Nevertheless, the benefits seen in this selected IPC group need to be followed up with a randomized trial. Second, although a significant difference was found in QoL scores between the groups (Table 2), the return rate of questionnaires was < 50%, which is often encountered in other studies of these terminally ill patients. Third, there was a nonsignificant (P = .18) trend toward a shorter follow-up time in the IPC group. This probably reflects the common clinical practice that (1) all patients with advanced disease and trapped lung were treated with IPC as pleurodesis was contraindicated, and (2) clinicians following conventional literature would only recommend pleurodesis to patients with a predicted survival of ≥ 3 months.4,13 Analysis of total hospital bed days as a proportion of follow-up time remained highly significant, suggesting that the result is likely to be robust, although a randomized study is still needed to definitively confirm this finding.

This study has shown that IPC treatment is safe and significantly avoids additional pleural procedures for fluid management. Patients with MPE (either from metastatic carcinoma or mesothelioma) who chose IPC management spent significantly less time in hospital compared with those who received pleurodesis. Randomized studies are now needed to compare IPC use as definitive first-line therapy to the traditional use of talc pleurodesis for recurrent symptomatic malignant effusions. These should confirm and define the magnitude of the benefits of IPC treatment and identify subgroups in whom the benefits may be most significant.

Author contributions: Dr Lee is guarantor of the study.

Dr Fysh: contributed to study conception and design, data collection and patient care, manuscript drafting and revision, and final approval of the manuscript.

Dr Waterer: contributed to study conception and design, manuscript drafting and revision, and final approval of the manuscript.

Dr Kendall: contributed to study conception and design, manuscript drafting and revision, and final approval of the manuscript.

Dr Bremner: contributed to data collection and patient care, manuscript drafting and revision, and final approval of the manuscript.

Ms Dina: contributed to data collection and patient care, manuscript drafting and revision, and final approval of the manuscript.

Dr Geelhoed: contributed to study conception and design, manuscript drafting and revision, and final approval of the manuscript.

Ms McCarney: contributed to data collection and patient care, manuscript drafting and revision, and final approval of the manuscript.

Ms Morey: contributed to study conception and design, data collection and patient care, manuscript drafting and revision, and final approval of the manuscript.

Mr Millward: contributed to study conception and design, data collection and patient care, manuscript drafting and revision, and final approval of the manuscript.

Dr Musk: contributed to study conception and design, data collection and patient care, manuscript drafting and revision, and final approval of the manuscript.

Dr Lee: contributed to study conception and design, data collection and patient care, manuscript drafting and revision, and final approval of the manuscript.

Financial/nonfinancial disclosures: The authors have reported to CHEST the following conflicts of interest: Dr Lee was a coinvestigator of the British Lung Foundation Therapeutic Intervention of Malignant Effusion-2 trial, for which catheters used were provided by Rocket Medical plc without charge. He received an honorarium from CareFusion Corporation as an advisory board member. Drs Fysh, Waterer, Kendall, Bremner, Geelhoed, and Musk; Mss Dina, McCarney, and Morey; and Mr Millward have reported that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Role of sponsors: The sponsors had no role in the design of the study, the collection and analysis of the data, or in the preparation of the manuscript.

IPC

indwelling pleural catheter

IQR

interquartile range

MID

minimally important difference

MPE

malignant pleural effusion

QoL

quality of life

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Van Meter ME, McKee KY, Kohlwes RJ. Efficacy and safety of tunneled pleural catheters in adults with malignant pleural effusions: a systematic review. J Gen Intern Med. 2011;26(1):70-76.
 

Figures

Figure Jump LinkFigure 1. Total number of days in hospital throughout the follow-up period from any cause of admission. Patients treated with IPCs spent significantly fewer days in hospital. IPC = indwelling pleural catheter; IQR = interquartile range.Grahic Jump Location
Figure Jump LinkFigure 2. Total number of days in hospital related to the effusion. See Figure 1 legend for expansion of abbreviations.Grahic Jump Location
Figure Jump LinkFigure 3. Median change in serum albumin and protein from initiation of therapy to death or 3-month follow-up. No significant depletion was seen in either group. Pleuro = pleurodesis. See Figure 1 legend for expansion of other abbreviations.Grahic Jump Location

Tables

Table Graphic Jump Location
Table 1 —Patient Characteristics

Data are presented as No. or No. (%) unless otherwise noted. No difference was found between the groups in their baseline demographic data, except for trapped lung, as expected. IPC = indwelling pleural catheter; IQR = interquartile range.

Table Graphic Jump Location
Table 2 —Short-term QoL and Dyspnea Scores

Data are presented as No. (%). The QoL and dyspnea scores were recorded immediately before and daily for the first 7 days after IPC insertion or pleurodesis. Complete QoL assessments were received from 15 of 34 (44.1%) and 12 of 31 (38.7%) patients of the IPC and pleurodesis groups, respectively, and completed dyspnea assessments from 15 of 34 (44.1%) and 14 of 31 (45.2%), respectively. QoL = quality of life. See Table 1 legend for expansion of other abbreviation.

Table Graphic Jump Location
Table 3 —Complication Rates During Study Period (Minimum 3 mo)

Data are presented as No. (%). See Table 1 legend for expansion of abbreviation.

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