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.
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.
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.
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.