CHEST
Volume 151, Issue 3, March 2017, Pages 626-635
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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

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

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