The Use of Indwelling Tunneled Pleural Catheters for Recurrent Pleural Effusions in Patients with Hematologic Malignancies: A Multicenter Study.
Chest. 2015 Mar 19;
Authors: Gilbert CR, Lee HJ, Skalski JH, Maldonado F, Wahidi M, Choi PJ, Bessich J, Sterman D, Argento AC, Shojaee S, Gorden JA, Wilshire CL, Feller-Kopman D, Ortiz R, Nonyane BA, Yarmus L
Abstract
BACKGROUND: Malignant pleural effusion remains a common complication of advanced malignancies. Indwelling tunneled pleural catheter placement provides effective palliation, but can be associated with complications, including infection. Hematologic malignancy in particular and the associated immunosuppressive treatment regimens may increase infectious complications. This study aimed to review the outcomes of hematological malignancy patients undergoing indwelling tunneled pleural catheter placement.
METHODS: A retrospective multicenter study of indwelling tunneled pleural catheters placed in hematologic malignancy patients from January 2009 to December 2013 was performed. Inclusion criteria included recurrent, symptomatic pleural effusion and underlying diagnosis of hematologic malignancy. Records were reviewed for patient demographics, operative reports, pathology, cytology, and microbiology reports.
RESULTS: A total of 91 patients were identified from eight institutions. The mean age was 65.4 years (SD +/- 15.4). The average in situ dwell time of all catheters was 89.9 days (SD +/- 127.1), with a total number of 8160 catheter days. A total of seven infectious complications were identified, all pleural space infections. All patients were admitted to the hospital for treatment, with four requiring additional pleural procedures. Two patients died from septic shock related to pleural infection.
CONCLUSION: We present the largest study examining clinical outcomes related to indwelling tunneled pleural catheter placement in patients with hematologic malignancy. An overall 7.7% infection risk and 2.2% mortality was identified, similar to previously reported studies, despite the significant immunosuppression and pancytopenia often present within this population. Indwelling tunneled pleural catheter placement appears to remain a reasonable clinical option for patients with recurrent pleural effusions related to hematologic malignancy.
PMID: 25789576 [PubMed - as supplied by publisher]