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Original Research: Pulmonary Procedures |

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 Hamid Alraiyes, MD; Kassem Harris, MD, FCCP
Author and Funding Information

FUNDING/SUPPORT: This work was supported by Roswell Park Cancer Institute and National Cancer Institute (NCI) [grant P30CA016056].

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

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

cDepartment of Medicine, Pulmonary Medicine, and Interventional Pulmonary Section, Roswell Park Cancer Institute, Buffalo, NY

dDepartment of Biostatistics and Bioinformatics, Roswell Park Cancer Institute, Buffalo, NY

CORRESPONDENCE TO: Kassem Harris MD, FCCP, Roswell Park Cancer Institute, Elm and Carlton St, Buffalo, NY 14263


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


Chest. 2017;151(3):626-635. doi:10.1016/j.chest.2016.10.052
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Published online

Background  The 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 effusion (BPE), replacing chemical pleurodesis. The purpose of this study is to analyze the efficacy and safety of IPC use in the management of refractory nonmalignant effusions.

Methods  We conducted a systematic review and meta-analysis on the published literature. Retrospective cohort studies, case series, and reports that used IPCs 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 cause of BPE requiring IPC placement. The estimated average rate of spontaneous pleurodesis was 51.3% (95% CI, 37.1%-65.6%). The estimated average rate of all complications was 17.2% (95% CI, 9.8%-24.5%) for the entire group. The estimated average rate of major complications included the following: empyema, 2.3% (95% CI, 0.0%-4.7%); loculation, 2.0% (95% CI, 0.0%-4.7%); dislodgement, 1.3% (95% CI, 0.0%-3.7%); leakage, 1.3% (95% CI, 0.0%-3.5%); and pneumothorax, 1.2% (95% CI, 0.0%-4.1%). The estimated average rate of minor complications included the following: skin infection, 2.7% (95% CI, 0.6%-4.9%); blockage and drainage failure, 1.1% (95% CI, 0.0%-3.5%); subcutaneous emphysema, 1.1% (95% CI, 0.0%-4.0%); and other, 2.5% (95% CI, 0.0%-5.2%). One death was directly related to IPC use.

Conclusions  IPCs are an effective and viable option in the management of patients with refractory BPE. The quality of evidence to support IPC use for BPE remains low, and high-quality studies such as randomized controlled trials are needed.

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