Disorders of the Pleura: Impact of Pleural Disorders |

Chronic Indwelling Pleural Catheter for Management of Refractory Non-Malignant Effusion: A Systematic Review and Meta-analysis FREE TO VIEW

Monali Patil, MD; Samjot Dhillon, MD; Kristopher Attwood, PhD; Marwan Saoud, MD; Kassem Harris, MD
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University at Buffalo, Buffalo, NY

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):582A. doi:10.1016/j.chest.2016.08.671
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SESSION TITLE: Impact of Pleural Disorders

SESSION TYPE: Original Investigation Slide

PRESENTED ON: Monday, October 24, 2016 at 07:30 AM - 08:30 AM

PURPOSE: Symptomatic benign refractory or recurrent pleural effusions represent a complex clinical conundrum due to limited therapeutic options. Indwelling pleural catheter (IPC), which was initially introduced for the management of recurrent malignant effusions could be a valuable management option for recurrent benign pleural effusions (BPE), in place of chemical pleurodesis.. IPC placement may not be permanent as it can result in pleurodesis and it can be removed subsequently. IPC placement for BPE is supported by small clinical trails and reports and large randomized clinical trials are lacking. The purpose of this study is to analyze the efficacy and safety of IPC in the management of refractory non-malignant effusions.

METHODS: We conducted a systematic review and meta-analysis on the published literature. Retrospective cohort studies, case series and reports that used indwelling pleural catheter for the management of pleural effusion were included in the study. Efficacy was assessed by rate of spontaneous pleurodesis and time to pleurodesis while safety was assessed by complication rate.

RESULTS: 16 studies were included in the analysis with a total of 329 patients. All patients were adults with age 27-95 years of age, 54.1.6% were men and 45.9% were women. Congestive heart failure (49.2%) was the most common etiology of BPE requiring IPC placement. The estimated average rate of spontaneous pleurodesis was 52.0% (95% C.I. 38%-68%). In subgroup analysis, the estimated average rate of spontaneous pleurodesis in cardiac cases was 42.1% (95%C.I. 20.1-64.1%) and in non-cardiac cases was 56.3% (95% C.I. 40.9%-71.1%). In terms of the safety outcomes, the estimated average rate of all complication was 16.9% (95% C.I 9.8-24.1) for the entire group. The estimated average rate of major complications was empyema 2.3 %( 95%C.I 0.0-4.7), loculation 2.0 %( 95%C.I 0.0%.4.7%), dislodgement, 1.3 %( 95%C.I 0.0%-3.7%), leak 1.3 %( 95% C.I 0.0%-3.5%) and pneumothorax 1.2 %( 95%C.I 0.0%, 4.1%). The estimated average rate of minor complications was skin infection 2.7% (95%C.I 0.6%, 4.9%), blockage and drainage failure 1.1% (95%C.I 0.0%-, 3.5%), subcutaneous emphysema 1.1% (95%C.I 0.0%, 4.0%) and others 2.5 %( 95%C.I 0.0,5.2%). One death was directly related to IPC use.

CONCLUSIONS: IPC is effective and a viable option in management of patients with refractory non-malignant pleural effusion with complication rate comparable to that of patients with malignant pleural effusion.

CLINICAL IMPLICATIONS: IPC could be considered in patients with refractory benign pleural effusion for palliation of symptoms secondary to the effusion, as currently there are very limited options in management of these patients. Patients should be carefully selected and managed in a center with experience in management of patients with chronic indwelling catheter.

DISCLOSURE: The following authors have nothing to disclose: Monali Patil, Samjot Dhillon, Kristopher Attwood, Marwan Saoud, Kassem Harris

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