The use of indwelling pleural catheters for the treatment of malignant pleural effusions

ABSTRACT

Introduction: The presence of a malignant pleural effusion (MPE) is a marker of advanced disease and associated with a poor prognosis. Patients are in a palliative stage of their disease and often suffer distressing symptoms including breathlessness and pain. Indwelling pleural catheters (IPCs) are effective in managing pleural effusions and allow ambulatory drainage of the pleural space, reducing symptoms associated with effusions and lowering overall hospital stay. The role of IPCs as a first line option in managing MPEs is expanding with a multitude of recent studies into the optimal application of IPCs, necessitating a review of the current literature.

Areas covered: This article will provide an overview of IPCs in MPE; how they’re inserted, their indications, continuing management, complications and possible future applications.

Expert opinion: IPCs should be considered first-line management of MPEs, alongside standard talc pleurodesis. Recognition of the advantages and disadvantages of each approach allows a more informed patient choice. It is recognized that the use of IPCs can provoke pleurodesis, leading to removal of the catheter. For patients in whom prompt removal of the catheter is a priority, then a more aggressive drainage regime or instillation of talc via the IPC is a reasonable option.

KEYWORDS:

• Malignant pleural effusion
• indwelling pleural catheter
• talc pleurodesis

Article highlights

• The presence of a Malignant Pleural Effusion (MPE) is a marker of advanced disease and associated with a poor prognosis

• Care should focus on palliating symptoms, reducing hospital stay and reducing pleural interventions.

• Indwelling pleural catheters (IPCs) offer a simple, effective method of managing MPEs as an outpatient.

• IPCs are associated with a shorter length of hospital stay and fewer ipsilateral pleural procedures than standard talc pleurodesis.

• IPCs are, however, associated with increased frequency of adverse events than standard talc pleurodesis, particularly infection

• Aggressive daily drainage regimes lead to increased pleurodesis rates.

• Instilling talc via the IPC doubles the likelihood of pleurodesis

• The IPC can be used as a port for intrapleural oncological therapies, as well as enabling serial monitoring of tumor and immune response.

• Future trials will further define the role of IPCs in MPE, as well as investigating the role of more sophisticating drug-eluting catheters.

Declaration of interest

One author has received honoraria for sitting on advisory boards for Carefusion/BD. The authors have nothing else to declare. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewers disclosure

Peer reviewers on this manuscript have no relevant financial relationships or otherwise to disclose.

Additional information

Funding

This manuscript was not funded.