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Chronic Indwelling Pleural Catheters for Malignant Pleural Effusions: Who Wants One?
October 2013, Vol 144, No. 4_MeetingAbstracts Disorders of the Pleura | October 2013
Chronic Indwelling Pleural Catheters for Malignant Pleural Effusions: Who Wants One? Lauren Angotti, MD; Matthew Divietro, DO; John Huggins, MD; Nicholas Pastis, MD; Peter Doelken, MD; Lisa Kaiser, RRT; Steven Sahn, MD Medical University of South Carolina, Charleston, SC Chest. 2013;144(4_MeetingAbstracts):510A. doi:10.1378/chest.1704217
Abstract SESSION TITLE: Pleural Disease Posters SESSION TYPE: Original Investigation Poster PRESENTED ON: Wednesday, October 30, 2013 at 01:30 PM - 02:30 PM PURPOSE: Pleural effusions related to underlying malignancy portend a grave prognosis, and patients often suffer from symptomatic dyspnea compromising quality of life. Current guidelines recommend chest tube placement with talc pleurodesis as first line therapy, but indwelling pleural catheters offer a safe and effective alternative, which can be performed on an outpatient basis. Importantly, they offer the advantage of placement in the setting of lung entrapment where pleurodesis would not be appropriate. METHODS: We identified 56 patients from 2003 to 2012 at the Medical University of South Carolina with malignant pleural effusions having indwelling catheters placed by pulmonologists. All cases were reviewed, to include initial pleural fluid analysis and imaging. Follow-up was possible until death or removal of indwelling catheter in most cases. RESULTS: Twenty-seven patients (48.2%) died with their catheter, 11 of them within two weeks of catheter placement. Twenty-six patients (46.5%) had them removed. Thirteen were removed when spontaneous pleurodesis or clinical response to therapy was achieved, 8 were removed for lack of effectiveness, 2 were removed at the time of surgical pleurodesis, 2 were removed for infection, and one was removed with no explanation. Three patients (5.3%) had no follow-up. CONCLUSIONS: Palliative relief was achieved in the majority of patients who either died with their catheter or had them removed. However, almost half of the people who died with their catheters did so within two weeks of placement. In addition, eight patients had their catheters removed due to lack of effectiveness, defined as minimal drainage with persistent dyspnea. Imaging in many of these cases demonstrated complex, loculated effusions. CLINICAL IMPLICATIONS: Indwelling pleural catheters continue to gain favor in the management of malignant pleural effusions. Our single center experience noted a lower
incidence of adverse events compared to those reported in recent literature, and also suggests that an objective algorithm may by helpful in determining who is most likely to truly receive benefit. DISCLOSURE: The following authors have nothing to disclose: Lauren Angotti, Matthew Divietro, John Huggins, Nicholas Pastis, Peter Doelken, Lisa Kaiser, Steven Sahn No Product/Research Disclosure Information
Chronic Indwelling Pleural Catheters for Malignant Pleural Effusions: Who Wants One? Lauren Angotti, MD; Matthew Divietro, DO; John Huggins, MD; Nicholas Pastis, MD; Peter Doelken, MD; Lisa Kaiser, RRT; Steven Sahn, MD Medical University of South Carolina, Charleston, SC Chest. 2013;144(4_MeetingAbstracts):510A. doi:10.1378/chest.1704217
Abstract SESSION TITLE: Pleural Disease Posters SESSION TYPE: Original Investigation Poster PRESENTED ON: Wednesday, October 30, 2013 at 01:30 PM - 02:30 PM PURPOSE: Pleural effusions related to underlying malignancy portend a grave prognosis, and patients often suffer from symptomatic dyspnea compromising quality of life. Current guidelines recommend chest tube placement with talc pleurodesis as first line therapy, but indwelling pleural catheters offer a safe and effective alternative, which can be performed on an outpatient basis. Importantly, they offer the advantage of placement in the setting of lung entrapment where pleurodesis would not be appropriate. METHODS: We identified 56 patients from 2003 to 2012 at the Medical University of South Carolina with malignant pleural effusions having indwelling catheters placed by pulmonologists. All cases were reviewed, to include initial pleural fluid analysis and imaging. Follow-up was possible until death or removal of indwelling catheter in most cases. RESULTS: Twenty-seven patients (48.2%) died with their catheter, 11 of them within two weeks of catheter placement. Twenty-six patients (46.5%) had them removed. Thirteen were removed when spontaneous pleurodesis or clinical response to therapy was achieved, 8 were removed for lack of effectiveness, 2 were removed at the time of surgical pleurodesis, 2 were removed for infection, and one was removed with no explanation. Three patients (5.3%) had no follow-up. CONCLUSIONS: Palliative relief was achieved in the majority of patients who either died with their catheter or had them removed. However, almost half of the people who died with their catheters did so within two weeks of placement. In addition, eight patients had their catheters removed due to lack of effectiveness, defined as minimal drainage with persistent dyspnea. Imaging in many of these cases demonstrated complex, loculated effusions. CLINICAL IMPLICATIONS: Indwelling pleural catheters continue to gain favor in the management of malignant pleural effusions. Our single center experience noted a lower
incidence of adverse events compared to those reported in recent literature, and also suggests that an objective algorithm may by helpful in determining who is most likely to truly receive benefit. DISCLOSURE: The following authors have nothing to disclose: Lauren Angotti, Matthew Divietro, John Huggins, Nicholas Pastis, Peter Doelken, Lisa Kaiser, Steven Sahn No Product/Research Disclosure Information