| Popis: |
Background: Indwelling pleural catheters (IPCs) are used routinely in recurrent malignant pleural effusions. There is no high quality evidence regarding their role in benign pleural effusions (BPE). Non randomized data suggests the utility of IPCs in symptomatic management of BPE due to systemic conditions refractory to medical treatment and repeated therapeutic thoracentesis. Aim: We aimed to study the role of IPCs in BPE in our cohort of pleural patients. Methods: We retrospectively analyzed all patients who had IPC at our institution from 2012 to 2017. Outcome measures included rate and time to pleurodesis, complications and associated mortality. Results: We reviewed 13 patients with BPE, out of 160 requiring IPC. Median age was 81 years. Underlying diagnoses included Congestive Cardiac Failure (CCF) (n=9, 69%), Hepatic Hydrothorax (HH) (n=2, 13%), combined CCF and HH (n=1, 8%) and Benign Asbestos Pleural Effusion (n=1, 8%). Patients had an average of 3 pleural procedures prior to IPC insertion. Effective pleurodesis was achieved in 4 patients (31%, all had CCF), median time to pleurodesis was 105 days. Complications included iatrogenic pneumothorax (n=2), blocked IPC needing removal (n=1), pleural infection (treated medically) (n=1) and wound infection (n=1). Median time to death was 40 days after IPC insertion (no death was attributed to IPC) thus pointing towards the advanced disease. Conclusion: IPCs have a role in the symptomatic management of BPE due to systemic conditions especially CCF. Physicians need to be very selective owing to the high peri-procedural mortality related to underlying disease. Ongoing REDUCE Trial will help us develop an evidence base in this patient cohort. |
