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Point and Counterpoint |

POINT: Should Small-Bore Pleural Catheter Placement Be the Preferred Initial Management for Malignant Pleural Effusions? YesSmall Pleural Catheter First Choice to Manage? Yes

Hans J. Lee, MD, FCCP; David J. Feller-Kopman, MD, FCCP
Author and Funding Information

From the Section of Interventional Pulmonology, Division Pulmonary and Critical Care, Johns Hopkins University.

CORRESPONDENCE TO: Hans J. Lee, MD, FCCP, The Johns Hopkins Hospital, 1800 Orleans St, Zayed Bldg 7125L, Baltimore, MD 21287; e-mail: hlee171@jhmi.edu


FINANCIAL/NONFINANCIAL DISCLOSURES: The authors have reported to CHEST the following conflicts: Dr Feller-Kopman has received consulting fees from CareFusion Inc. This editorial reflects Dr Feller-Kopman’s independent thoughts regarding the use of small-bore catheters in the treatment of pleural effusions. Dr Lee reports no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

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


Chest. 2015;148(1):9-10. doi:10.1378/chest.15-0424
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Extract

The ultimate goal for the management of malignant pleural effusion (MPE) is to relieve dyspnea and avoid multiple procedures that would interfere with a patient’s quality of life. Therapeutic options include the use of oxygen and morphine for patients with an extremely limited life expectancy, repeat thoracentesis, placement of a tunneled pleural catheter (TPC), and pleurodesis. Because nearly 100% of MPEs will recur within 1 month, repeat thoracentesis often is used for patients with an expected survival < 4 weeks. It stands to reason that the least invasive methods that will provide long-term relief should be used for patients expected to survive > 1 month. Not surprisingly, a small-bore TPC is recommended by British Thoracic Society guidelines1 for the management of MPE.

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