CHEST
Volume 151, Issue 3, March 2017, Pages 626-635
Journal home page for CHEST

Original Research: Pulmonary Procedures
Management of Benign Pleural Effusions Using Indwelling Pleural Catheters: A Systematic Review and Meta-analysis

https://doi.org/10.1016/j.chest.2016.10.052Get rights and content

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.

Section snippets

Search Methodology

A literature search was conducted using the electronic database engines PubMed, Cochrane database, EMBASE, and MEDLINE from January 2011 to January 2016 to identify published reports addressing outcomes in patients treated with an IPC for the treatment of pleural effusion due to benign conditions. The following words were used as the search keys: “indwelling pleural catheter,” “PleurX catheter,” “pleural catheter,” “tunneled pleural catheter,” “benign pleural effusion,” “refractory nonmalignant

Results

Based on the search criteria, we reviewed 391 records. Of the 391 records, only 30 papers were eligible for further review. Two studies were excluded because IPC was used in the management of cases with underlying hematologic malignancies and after lung transplantation.17, 18, 19 Although the post-lung-transplantation pleural effusions were benign in nature, pleurodesis would be significantly affected by the thoracic surgery, and the role of the IPC in achieving pleurodesis is questionable.

Discussion

The results of our analysis show that IPCs can be used effectively in the management of BPEs, with an estimated spontaneous pleurodesis rate of 51.3%, and could be considered in patients with refractory BPE for palliation. These results are similar to the meta-analysis conducted in a MPE population, which reported a spontaneous pleurodesis rate of 45%.33 To our knowledge, this is the first meta-analysis that addresses the use of IPC in the management of BPE. We acknowledge that the major

Conclusions

We conclude that IPC is an acceptable therapeutic option for the management of refractory pleural effusion secondary to benign conditions. The overall complication rate of IPC is comparable to the complication rate in MPE but with a longer IPC placement period. Studies of higher quality are required further to evaluate the use of IPC in the treatment of BPE.

Acknowledgments

Author contributions: K. H. is the guarantor of the paper, taking responsibility for the integrity of the work as a whole, from inception to published article. M. P., K. A., and K. H. contributed substantially to the review design, data interpretation, and writing of the manuscript. S. D., A. H. A., and M. S. contributed to the review design and data interpretation of the manuscript.

Financial/nonfinancial disclosures: The authors have reported to CHEST the following: K. H. and A. H. A. are

References (44)

  • R.K. Freeman et al.

    A propensity-matched comparison of pleurodesis or tunneled pleural catheter in patients undergoing diagnostic thoracoscopy for malignancy

    Ann Thorac Surg

    (2013)
  • M. Krishnan et al.

    The untapped potential of tunneled pleural catheters

    Ann Thorac Surg

    (2015)
  • S.C. Murthy et al.

    A simple solution for complicated pleural effusions

    J Thorac Oncol

    (2006)
  • D.D. Borgeson et al.

    Chronic indwelling pleural catheters reduce hospitalizations in advanced heart failure with refractory pleural effusions

    J Card Fail

    (2009)
  • J.P. Kilburn et al.

    Use of indwelling tunneled pleural catheters for the management of hepatic hydrothorax

    Chest

    (2010)
  • N. Parsaei et al.

    Use of long-term indwelling tunneled pleural catheter for the management of benign pleural effusion

    Chest

    (2006)
  • T. Bakirci et al.

    Pleural effusion in long-term hemodialysis patients

    Transplant Proc

    (2007)
  • B.M. Hunt et al.

    Thoracoscopic talc versus tunneled pleural catheters for palliation of malignant pleural effusions

    Ann Thorac Surg

    (2012)
  • D. Davidoff et al.

    The use of pleurodesis for intractable pleural effusion due to congestive heart failure

    Postgrad Med J

    (1983)
  • A.J. Ghio et al.

    Talc should not be used for pleurodesis in patients with nonmalignant pleural effusions

    Am J Respir Crit Care Med

    (2001)
  • R.W. Light

    Talc should not be used for pleurodesis

    Am J Respir Crit Care Med

    (2000)
  • R. Bhatnagar et al.

    Indwelling pleural catheters for non-malignant effusions: a multicentre review of practice

    Thorax

    (2014)
  • Cited by (56)

    • Double trouble: Biochemically confirmed bilateral chylothorax with positive pleural fluid cytology due to breast adenocarcinoma

      2022, Respiratory Medicine Case Reports
      Citation Excerpt :

      The patient was deemed unfit for further disease-modifying therapy and was discharged home with hospice services. Chylothorax results from the accumulation in the pleural space of chyle-containing lymphatic fluid normally flowing through the thoracic duct (TD) and accounts for 2%–4% of pleural effusions [1,2]. The appearance of PF is commonly described as turbid or milky, but that is a variable finding.

    • Pleural Interventions in the Management of Hepatic Hydrothorax

      2022, Chest
      Citation Excerpt :

      Additionally, a review of nonmalignant pleural effusions reports spontaneous pleurodesis rates of greater than 50%, but closer analysis of the data is more disappointing. This report is hindered by a heterogeneous population (only 12% with HH) and that many reported pleurodesis events occurring after transplantation, perhaps confusing true pleurodesis rates vs simple resolution of HH.30 Complications rates including empyema (2.3%-4.5%) and catheter blockage (1.1%-2.9%) are also reported.

    • Pleural Effusion: Hepatic Hydrothorax

      2021, Encyclopedia of Respiratory Medicine, Second Edition
    • Bilateral Asymmetrical Pleural Effusion Due to Congestive Heart Failure

      2021, Pleural Diseases: Clinical Cases and Real-World Discussions
    View all citing articles on Scopus

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

    View full text