Abstract
Indwelling pleural catheters (IPCs) have an established role in the management of recurrent pleural effusions due to malignancy. They are typically used in patients with trapped lung, those who have previously failed an attempted talc pleurodesis, or as first-line therapy. Experience of, and evidence for, IPC use in this setting is well established. In contrast, IPC use in patients with recurrent pleural effusions due to benign disease is limited, and there are no randomized studies evaluating their efficacy and safety in this patient group. Retrospective data suggest that IPCs may be effective at reducing breathlessness with acceptable complication rates, comparable to those seen in malignant effusions. This paper summarizes the epidemiology, pathophysiology and treatment options for benign pleural effusions, and reviews the published data assessing IPC use in this population.
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Davies HE, Mishra EK, Kahan BC, et al. Effect of an indwelling pleural catheter vs chest tube and talc pleurodesis for relieving dyspnea in patients with malignant pleural effusion: the TIME2 randomized controlled trial. JAMA. 2012;307(22):2383–9. A large randomized controlled trial evaluating comparing indwelling pleural catheters with talc pleurodesis on levels of daily breathlessness in patients with a malignant pleural effusion.
Stewart S, MacIntyre K, Capewell S, McMurray JJ. Heart failure and the aging population: an increasing burden in the 21st century? Heart. 2003;89(1):49–53.
Younossi ZM, Stepanova M, Afendy M, et al. Changes in the prevalence of the most common causes of chronic liver diseases in the United States from 1988 to 2008. Clin Gastroenterol Hepatol. 2011;9(6):524–30.
FDA. Summary of safety and effectiveness Denver PleurX Pleural Catheter Kit, Denver PleurX Home Drainage Kit. Food and Drug Administration Editor. 1997; Rockville MD.
FDA. PleurX Pleural Catheter and Drainage Kits. Food and Drug Administration Editor. 2001; Rockville, MD.
Olden AM, Holloway R. Treatment of malignant pleural effusion: PleuRx catheter or talc pleurodesis? A cost-effectiveness analysis. J Palliat Med. 2010;13(1):59–65.
Puri V, Pyrdeck TL, Crabtree TD, et al. Treatment of malignant pleural effusion: a cost-effectiveness analysis. Ann Thorac Surg. 2012;94(2):374–9.
Strauss RM, Boyer TD. Hepatic hydrothorax. Semin Liver Dis. 1997;17(3):227–32.
Xiol X, Guardiola J. Hepatic hydrothorax. Curr Opin Pulm Med. 1998;4(4):239–42.
Bhatnagar R, Reid ED, Corcoran JP, et al. Indwelling pleural catheters for non-malignant effusions: a multicentre review of practice. Thorax. 2013. doi:10.1136/thoraxjnl-2013-204563. A series of 57 cases evaluating the use of IPCs in non-malignant recurrent effusions documenting indications, complications and rates of pleurodesis.
Rubinstein D, McInnes IE, Dudley FJ. Hepatic hydrothorax in the absence of clinical ascites: diagnosis and management. Gastroenterology. 1985;88(1 Pt 1):188–91.
Machicao VI, Balakrishnan M, Fallon MB. Pulmonary complications in chronic liver disease. Hepatology. 2013. doi:10.1002/hep.26745.
Xiol X, Tremosa G, Castellote J, et al. Liver transplantation in patients with hepatic hydrothorax. Transpl Int. 2005;18(6):672–5.
Siegerstetter V, Deibert P, Ochs A, et al. Treatment of refractory hepatic hydrothorax with transjugular intrahepatic portosystemic shunt: long-term results in 40 patients. Eur J Gastroenterol Hepatol. 2001;13(5):529–34.
Gordon FD, Anastopoulos HT, Crenshaw W, et al. The successful treatment of symptomatic, refractory hepatic hydrothorax with transjugular intrahepatic portosystemic shunt. Hepatology. 1997;25(6):1366–9.
McMurray JJ, Stewart S. Epidemiology, aetiology, and prognosis of heart failure. Heart. 2000;83(5):596–602.
Morgan S, Smith H, Simpson I, et al. Prevalence and clinical characteristics of left ventricular dysfunction among elderly patients in general practice setting: cross sectional survey. BMJ. 1999;318(7180):368–72.
Kataoka H. Pericardial and pleural effusions in decompensated chronic heart failure. Am Heart J. 2000;139(5):918–23.
Woodring JH. Distribution of pleural effusion in congestive heart failure: what is atypical? South Med J. 2005;98(5):518–23.
Natanzon A, Kronzon I. Pericardial and pleural effusions in congestive heart failure-anatomical, pathophysiologic, and clinical considerations. Am J Med Sci. 2009;338(3):211–6.
Bakirci T, Sasak G, Ozturk S, et al. Pleural effusion in long-term hemodialysis patients. Transplant Proc. 2007;39(4):889–91.
Vargas FS, Cukier A, Hueb W, et al. Relationship between pleural effusion and pericardial involvement after myocardial revascularization. Chest. 1994;105(6):1748–52.
Light RW. Pleural effusions following cardiac injury and coronary artery bypass graft surgery. Semin Respir Crit Care Med. 2001;22(6):657–64.
Sadikot RT, Rogers JT, Cheng DS, et al. Pleural fluid characteristics of patients with symptomatic pleural effusion after coronary artery bypass graft surgery. Arch Intern Med. 2000;160(17):2665–8.
Light RW. Pleural effusions after coronary artery bypass graft surgery. Curr Opin Pulm Med. 2002;8(4):308–11.
Light RW, Rogers JT, Moyers JP, et al. Prevalence and clinical course of pleural effusions at 30 days after coronary artery and cardiac surgery. Am J Respir Crit Care Med. 2002;166(12 Pt 1):1567–71.
Ryu JH, Tomassetti S, Maldonado F. Update on uncommon pleural effusions. Respirology. 2011;16(2):238–43.
Maldonado F, Cartin-Ceba R, Hawkins FJ, Ryu JH. Medical and surgical management of chylothorax and associated outcomes. Am J Med Sci. 2010;339(4):314–8.
Davies HE, Rahman NM, Parker RJ, Davies RJ. Use of indwelling pleural catheters for chronic pleural infection. Chest. 2008;133(2):546–9.
Hooper C, Lee Y, Maskell N. Investigation of a unilateral pleural effusion in adults: British Thoracic Society pleural disease guideline 2010. Thorax. 2010;65 Suppl 2:ii4–ii17.
McVay PA, Toy PT. Lack of increased bleeding after paracentesis and thoracentesis in patients with mild coagulation abnormalities. Transfusion. 1991;31(2):164–71.
Hooper CE, Welham S, Maskell NA. Pleural procedures and patient safety—a national BTS audit of practice. Thorax. 2014 (in press).
Roberts M, Neville E, Berrisford R, et al. Management of a malignant pleural effusion: British Thoracic Society pleural disease guideline 2010. Thorax. 2010;65 Suppl 2:ii32–40.
Steger V, Mika U, Toomes H, et al. Who gains most? A 10-year experience with 611 thoracoscopic talc pleurodeses. Ann Thorac Surg. 2007;83(6):1940–5.
Glazer M, Berkman N, Lafair JS, Kramer MR. Successful talc slurry pleurodesis in patients with nonmalignant pleural effusion. Chest. 2000;117(5):1404–9.
Sudduth CD, Sahn SA. Pleurodesis for nonmalignant pleural effusions. Recommendations. Chest. 1992;102(6):1855–60.
Ghio AJ, Roggli V, Light RW. Talc should not be used for pleurodesis in patients with nonmalignant pleural effusions. Am J Respir Crit Care Med. 2001;164(9):1741.
Light RW. Talc should not be used for pleurodesis. Am J Respir Crit Care Med. 2000;162(6):2024–6.
Maskell NA, Lee YC, Gleeson FV, et al. Randomized trials describing lung inflammation after pleurodesis with talc of varying particle size. Am J Respir Crit Care Med. 2004;170(4):377–82.
Lee WJ, Kim HJ, Park JH, et al. Chemical pleurodesis for the management of refractory hepatic hydrothorax in patients with decompensated liver cirrhosis. Korean J Hepatol. 2011;17(4):292–8.
Davidoff D, Naparstek Y, Eliakim M. The use of pleurodesis for intractable pleural effusion due to congestive heart failure. Postgrad Med J. 1983;59(691):330–1.
de Campos JR M, Filho LO, de Campos Werebe E, et al. Thoracoscopy and talc poudrage in the management of hepatic hydrothorax. Chest. 2000;118(1):13–7.
Ferrante D, Arguedas MR, Cerfolio RJ, et al. Video-assisted thoracoscopic surgery with talc pleurodesis in the management of symptomatic hepatic hydrothorax. Am J Gastroenterol. 2002;97(12):3172–5.
DePew ZS, Iqbal S, Mullon JJ, et al. The role for tunneled indwelling pleural catheters in patients with persistent benign chylothorax. Am J Med Sci. 2013;346(5):349–52. A retrospective of 11 patients with a chylothorax treated with an IPC documenting a low complication rate and high rates of pleurodesis.
Srour N, Potechin R, Amjadi K. Use of indwelling pleural catheters for cardiogenic pleural effusions. Chest. 2013;144(5):1603–8. A study evaluating the use of IPCs in 38 patients with cardiogenic pleural effusions, the use of which was associated with an improvement in dyspnea.
Imler T, Abdel-jawad K, Kwo P, et al. To drain or not drain: Pleurx indwelling drainage catheters for non-malignant refractory ascites or hepatic hydrothorax. Thorac Cardiovasc Surg. 2012;107:S145.
Chalhoub M, Harris K, Castellano M, et al. The use of the PleurX catheter in the management of non-malignant pleural effusions. Chron Respir Dis. 2011;8(3):185–91. A retrospective study including 23 patients with varied causes of non-malignant pleural effusion treated with IPCs, demonstrating high levels of patient satisfaction and a pleurodesis rate of 100 %.
Mullon J, Maldonado F. Use of tunneled indwelling pleural catheters for palliation of nonmalignant pleural effusions. Chest. 2011;140(4 Meeting Abstract):996A.
Mercky P, Sakr L, Heyries L, et al. Use of a tunnelled pleural catheter for the management of refractory hepatic hydrothorax: a new therapeutic option. Respiration. 2010;80(4):348–52.
Kilburn JP, Hutchings J, Misselhorn D, Chen AC. Use of indwelling tunneled pleural catheters for the management of hepatic hydrothorax. Chest. 2010;138(4 MeetingAbstracts):418A.
Vakil N, Su J, Mason D, et al. Allograft entrapment after lung transplantation: a simple solution using a pleurocutaneous catheter. Thorac Cardiovasc Surg. 2010;58(5):299–301.
Borgeson D, Defranchi S, Lam C, et al. Chronic indwelling pleural catheters reduce hospitalizations in advanced heart failure with refractory pleural effusions. J Card Fail. 2009;15(6 Suppl 1):S105.
French S, Ferraro D, Bell D. Bilateral tunneled pleural catheters for nonmalignant pleural effusions secondary to superior vena cava thrombosis. Chest. 2009;136(4 Meeting Abstract):63S.
Herlihy J, Loyalka P, Gnananandh J, et al. PleurX catheter for the management of refractory pleural effusions in congestive heart failure. Tex Heart Inst J. 2009;36(1):38–43.
Schneider T, Reimer P, Storz K, et al. Recurrent pleural effusion: who benefits from a tunneled pleural catheter? Thorac Cardiovasc Surg. 2009;57(1):42–6.
Parsaei N, Khodaverdian R, McKelvey AA, et al. Use of long-term indwelling tunneled pleural catheter for the management of benign pleural effusion. Chest. 2006;130(4 Meeting Abstract):271S.
Murthy SC, Okereke I, Mason DP, Rice TW. A simple solution for complicated pleural effusions. J Thorac Oncol. 2006;1(7):697–700.
Warren WH, Kim AW, Liptay MJ. Identification of clinical factors predicting Pleurx catheter removal in patients treated for malignant pleural effusion. Eur J Cardiothorac Surg. 2008;33(1):89–94.
Van Meter ME, McKee KY, Kohlwes RJ. Efficacy and safety of tunneled pleural catheters in adults with malignant pleural effusions: a systematic review. J Gen Intern Med. 2011;26(1):70–6.
Tremblay A, Michaud G. Single-center experience with 250 tunnelled pleural catheter insertions for malignant pleural effusion. Chest. 2006;129(2):362–8.
Fysh ET, Tremblay A, Feller-Kopman D, et al. Clinical outcomes of indwelling pleural catheter-related pleural infections: an international multicenter study. Chest. 2013;144(5):1597–602.
Machleder HI, Paulus H. Clinical and immunological alterations observed in patients undergoing long-term thoracic duct drainage. Surgery. 1978;84(1):157–65.
Jimenez CA, Mhatre AD, Martinez CH, et al. Use of an indwelling pleural catheter for the management of recurrent chylothorax in patients with cancer. Chest. 2007;132(5):1584–90.
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Nick Maskell reports receiving honoraria for sitting on a CareFusion advisory board, and an unrestricted research grant for IPC-Plus Study. Oliver Bintcliffe and David Arnold report no conflicts of interest.
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Bintcliffe, O.J., Arnold, D.T. & Maskell, N.A. Indwelling pleural catheters for benign pleural effusions. Curr Respir Care Rep 3, 61–70 (2014). https://doi.org/10.1007/s13665-014-0073-5
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DOI: https://doi.org/10.1007/s13665-014-0073-5