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Vol. 45. Issue 12.
Pages 591-596 (December 2009)
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Vol. 45. Issue 12.
Pages 591-596 (December 2009)
Original article
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Use of Indwelling Pleural Catheter in the Outpatient Management of Recurrent Malignant Pleural Effusion
Uso del drenaje pleural permanente en el manejo ambulatorio del derrame pleural maligno recidivante
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Enrique Casesa,
Corresponding author
cases_enr@gva.es

Corresponding author.
, Luis Seijob, Carlos Disdierc, María José Lorenzoa, Rosa Cordovillad, Francisca Sanchisa, Marimar Lacunzab, Gregoria Sevillanoc, Fátima Benito-Sendínd
a Servicio de Neumología, Hospital Universitario La Fe, Valencia, Spain
b Departamento de Neumología, Clínica Universitaria de Navarra, Pamplona, Navarra, Spain
c Sección de Neumología, Hospital San Pedro de Alcántara, Centro de Investigaciones Biomédicas en Red (CIBER) de Enfermedades Respiratorias, Cáceres, Spain
d Servicio de Neumología, Hospital Universitario Salamanca, Salamanca, Spain
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Abstract
Introduction

To analyse the effectiveness and safety of the indwelling pleural catheter in the management of recurrent malignant pleural effusion.

Patients and methods

A prospective multicentre study was performed in 63 consecutive outpatients from four Spanish hospitals. A total of 43 men and 20 women were included, with a median age of 67 years. In seven of the cases treatment with pleurodesis had failed; in five other cases their lung was trapped; in another five cases after repeat therapeutic thoracocentesis, and the rest of them as a preference choice to pleurodesis. All patients had an indwelling pleural catheter inserted (PleurX®, Denver Biomedical).

Results

Most of patients (94.5%) reported an improvement in their respiratory symptoms (cough and dyspnoea) and their ability to function independently. Average length of the catheterisation was 45 days (6-222). Average amount of drained pleural effusion was 75 ml, with a frequency of drainage of between 3 and 4 times per week and once fortnightly. Spontaneous pleurodesis was achieved following 34.9% of procedures. No complications occurred during the insertion of the catheter. The post-catheterisation complications were empyema (3 cases), chest pain (2 cases), and tumour metastasis (3 cases).

Conclusions

The use of an indwelling pleural catheter is an effective palliative treatment in the outpatient management for patients suffering malignant pleural effusion. It is also a simple treatment that can be easily applied, does not require hospitalisation and can be easily managed by the patient at home, with a low rate of complications.

Keywords:
Malignant pleural effusion
Indwelling catheter
Outpatient
Resumen
Introducción

El objetivo del estudio ha sido analizar la eficacia y seguridad del catéter de drenaje pleural permanente en el manejo de pacientes con diagnóstico de derrame pleural maligno.

Pacientes y métodos

Se ha realizado un estudio prospectivo y multicéntrico de 63 pacientes consecutivos de 4 hospitales españoles. Se incluyó a 43 varones y 20 mujeres, con una mediana de edad de 67 años, diagnosticados de derrame pleural maligno sintomático. En 7 casos el tratamiento se indicó tras fracaso de pleurodesis, en 5 por encontrarse el pulmón atrapado, en otros 5 tras toracocentesis repetidas y en el resto como indicación preferente a la pleurodesis. A todos los pacientes se les insertó de forma ambulatoria un catéter tunelizado permanente (PleurX®, Denver Biomedical).

Resultados

La mayoría de los pacientes (95,4%) refirió mejoría parcial o completa de los síntomas respiratorios (tos y disnea) y de su capacidad funcional. La mediana de duración de uso del catéter fue de 45 días (rango: 6-222). La mediana diaria de líquido pleural drenado fue de 75 ml. En 22 casos (34,9%) se produjo una pleurodesis espontánea. No se registraron complicaciones durante la inserción del catéter. Las complicaciones durante el seguimiento fueron las siguientes: empiema (3 casos), dolor torácico (2 casos) y diseminaciones del tumor por el lugar de inserción del tubo (3 casos).

Conclusiones

El catéter de drenaje pleural permanente es eficaz en el manejo ambulatorio del paciente con derrame pleural maligno sintomático. Es un procedimiento sencillo que no precisa ingreso hospitalario, de fácil manejo para el paciente en su domicilio y con escasas complicaciones.

Palabras clave:
Derrame pleural maligno
Catéter pleural tunelizado permanente
Paciente ambulatorio
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Copyright © 2009. Sociedad Española de Neumología y Cirugía Torácica
Archivos de Bronconeumología
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