Indwelling pleural catheters for non-malignant pleural effusions: report on a single centre’s 10 years of experience

• Published in: BMJ open respiratory research Vol. 7; no. 1; p. e000501
• Main Authors: Frost, Nikolaj, Ruwwe-Glösenkamp, Christoph, Raspe, Matthias, Brünger, Martin, Temmesfeld-Wollbrück, Bettina, Suttorp, Norbert, Witzenrath, Martin
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 01-01-2020; BMJ Publishing Group
• Subjects: Age; Ambulatory care; Catheters; Demographics; Heart failure; Liver cirrhosis; Patients; Pleural Disease; Proteins; United States > US; pleural disease; palliative care
• ISSN: 2052-4439; 2052-4439
• DOI: 10.1136/bmjresp-2019-000501

BackgroundRecurrent pleural effusion is a common cause of dyspnoea, cough and chest pain during the course of infectious pleurisy and non-malignant diseases like congestive heart failure (CHF) or liver cirrhosis with hepatic hydrothorax (HH). With regard to the chronic character of the underlying diseases, indwelling pleural catheters (IPC) are increasingly used, not only assuring immediate symptom relief but also potentially leading to pleurodesis without sclerosing agents.Patients and methodsIn this single-centre retrospective observational study, patient characteristics, procedural variables and outcome in patients with IPC in non-malignant pleural effusion (NMPE) were evaluated and prognostic factors for pleurodesis were identified.ResultsFrom 2006 to 2017, 54 patients received 62 IPC, of whom 48.4% with CHF and 43.5% with HH. The median length of insertion was 1.5 months (IQR 0.6–2.9 months), the median survival time after insertion 3.2 months (IQR 1.1–16.0). An adequate symptom relief was achieved in 93.2% with no need for subsequent interventions. In patients surviving ≥30 days after IPC insertion, pleurodesis was observed in 45.9%, being associated to age (<55 years, p=0.02), the primary diagnosis (p=0.03) and interventions for the underlying disease (p<0.001). Complications occurred in 24.2% of all procedures (n=15), the majority concerning mechanical obstructions (n=10) and infections (n=4). Patients with HH had an excess risk for complications (37.3%).ConclusionEfficacy in symptom relief and a generally manageable safety profile recommend IPC as a first-line treatment option in NMPE, where disease-specific treatments are exhausted. Caution is warranted in patients with HH due to an excess risk for complications.