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Original Research |

The Management of Benign Pleural Effusions using Indwelling Pleural Catheters - A Systematic Review and Meta-Analysis

Monali Patil, MD; Samjot Singh Dhillon, MD; Kristopher Attwood, PhD; Marwan Saoud, MD; Abdul H. Alraiyes, MD; Kassem Harris, MD
Author and Funding Information

Funding, Conflicts of Interest and Disclosures: This work was supported by Roswell Park Cancer Institute and National Cancer Institute (NCI) grant P30CA016056.

KH and AHA are consultants for Cook Medical. MP, SD, KA, and MS have no conflict of interest.

1Department of Pulmonary, Critical Care and Sleep Medicine, State University of New York (SUNY) at Buffalo, NY

2Department of Medicine, Pulmonary Medicine &Interventional Pulmonary Section, Roswell Park Cancer Institute, Buffalo, NY

3Roswell Park Cancer Institute, Department of Biostatistics and Bioinformatics

4Department of Internal Medicine, State University of New York (SUNY) at Buffalo, NY

Address of Corresponding Author: Corresponding author: Kassem Harris MD, FCCP Roswell Park Cancer Institute Elm & Carlton Streets Buffalo, NY 14263.


Copyright 2016, . All Rights Reserved.


Chest. 2016. doi:10.1016/j.chest.2016.10.052
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Abstract

Introduction  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. 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.

Results  Thirteen studies were included in the analysis with a total of 325 patients. Congestive heart failure (49.8%) was the most common etiology of BPE requiring IPC placement. The estimated average rate of spontaneous pleurodesis was 51.3% (95% C.I. 37.1%-65.6%). The estimated average rate of all complications was 17.2% (95% C.I 9.8-24.5%) 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 the management of patients with refractory benign pleural effusion. The quality of evidence to support the IPC use for BPE remains low, and high-quality studies such as randomized control trials are needed.


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