Use of indwelling pleural catheters for cardiogenic pleural effusions.
Chest. 2013 Jun 27;
Authors: Srour N, Potechin R, Amjadi K
ABSTRACT BACKGROUND: Cardiogenic pleural effusions are rarely refractory to treatment of the underlying disease. Few options are available in these cases. Indwelling pleural catheter (IPC) insertion has been well described for management of malignant pleural effusions. We present our experience with using IPCs for cardiogenic pleural effusion management.
METHODS: We prospectively constructed a cohort of patients who underwent IPC insertion for cardiogenic pleural effusions. Patients were carefully selected and the IPCs were inserted as a palliative measure or while awaiting cardiac transplantation.
RESULTS: There were 43 IPCs inserted in 38 patients. Patients had significant dyspnea with a mean baseline dyspnea index of 2.24 (95% CI 1.53-2.94). There was significant improvement in dyspnea 2 weeks after IPC insertion with a mean transitional dyspnea index of 6.19 (95% CI 5.56-6.82). There was no occurrence of empyema. Pneumothorax, mostly ex vacuo, occurred in 11.6% of procedures but did not require further intervention. IPCs were removed in 18 patients (47.4%) and successful spontaneous pleurodesis occurred in 11 patients (29.0%) after a median of 66 days (IQR 34-242). Patients who eventually had their catheters removed had had better performance status (p=0.008) and had been less dyspneic (p=0.005) at baseline, and had longer survival (p<0.0001).
CONCLUSION: Indwelling pleural catheter insertion for cardiogenic pleural effusion is a feasible option in carefully selected patients. Further research is needed to confirm our results and assess the impact of indwelling pleural catheter insertion on the quality of life of these patients.
PMID: 23807028 [PubMed - as supplied by publisher]