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Pleurodesis Following Tunneled Pleural Catheter Placement in Non-Malignant Pleural Effusions
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A4223 - Pleurodesis Following Tunneled Pleural Catheter Placement in Non-Malignant Pleural Effusions
Author Block: J. Hirsh1, J. Puchalski1, K. Araujo2, M. A. Pisani1; 1Yale University School of Medicine, New Haven, CT, United States, 2Claude D. Pepper Older Americans Independence Center at Yale, Program on Aging, New Haven, CT, United States.
Rationale: The tunneled pleural catheter (TPC) was approved by the FDA in 1997 and has since been used to manage recurrent pleural effusions. There is an improvement in quality of life and dyspnea in TPC recipients. Studies looking at spontaneous pleurodesis from TPCs exist, however, there is limited data on this outcome in those who receive a TPC for non-malignant pleural effusion (MPE).
Methods: A retrospective chart review was undertaken looking at 150 patients in whom a TPC was placed by the Interventional Pulmonary service between January 2013 and November 2015. Twenty-nine patients were excluded due to confounding factors such as medical thoracoscopy or chemical pleurodesis. Data on prior thoracentesis, pleurodesis, mortality, and complications, including infection, pneumothorax, and catheter malfunction were recorded. Pleurodesis was defined as minimal output with minimal residual effusion as per the chart. The time to and indication for removal of TPC were assessed. In patients with non-MPE, etiology was recorded. In patients with MPE, additional variables captured included malignancy type and treatment received.
Results: Of the 121 participants, mean age in years was 67.4 (+/-14.6) in non-MPE and 62.9 (+/-15.3) in MPE. Non-MPE was the indication for TPC placement in 22%, most commonly due to heart failure or cirrhosis. TPC in MPE was most commonly placed for breast or lung cancer. Overall rate of pleurodesis was 41% in non-MPE and 22% in MPE. Time to pleurodesis in days was 43 (IQR=69) and 23 (IQR=25), respectively. The overall rate of removal in the cohorts was 63% in non-MPE and 32% in MPE. Time to death in days was 253 (IQR=400) and 40 (IQR=97), respectively. Most patients with MPE died with their TPC in place, likely accounting for the lower rates of pleurodesis and rate of removal.
Conclusion: This study adds to the limited literature regarding TPC placement in non-MPE. Pleurodesis was accomplished in a minority of patients with non-MPE. Given survival is longer in patients with non-MPE than those with MPE, additional studies are required to determine costs, benefits and appropriate alternatives to TPC placement in this population.
Author Block: J. Hirsh1, J. Puchalski1, K. Araujo2, M. A. Pisani1; 1Yale University School of Medicine, New Haven, CT, United States, 2Claude D. Pepper Older Americans Independence Center at Yale, Program on Aging, New Haven, CT, United States.
Rationale: The tunneled pleural catheter (TPC) was approved by the FDA in 1997 and has since been used to manage recurrent pleural effusions. There is an improvement in quality of life and dyspnea in TPC recipients. Studies looking at spontaneous pleurodesis from TPCs exist, however, there is limited data on this outcome in those who receive a TPC for non-malignant pleural effusion (MPE).
Methods: A retrospective chart review was undertaken looking at 150 patients in whom a TPC was placed by the Interventional Pulmonary service between January 2013 and November 2015. Twenty-nine patients were excluded due to confounding factors such as medical thoracoscopy or chemical pleurodesis. Data on prior thoracentesis, pleurodesis, mortality, and complications, including infection, pneumothorax, and catheter malfunction were recorded. Pleurodesis was defined as minimal output with minimal residual effusion as per the chart. The time to and indication for removal of TPC were assessed. In patients with non-MPE, etiology was recorded. In patients with MPE, additional variables captured included malignancy type and treatment received.
Results: Of the 121 participants, mean age in years was 67.4 (+/-14.6) in non-MPE and 62.9 (+/-15.3) in MPE. Non-MPE was the indication for TPC placement in 22%, most commonly due to heart failure or cirrhosis. TPC in MPE was most commonly placed for breast or lung cancer. Overall rate of pleurodesis was 41% in non-MPE and 22% in MPE. Time to pleurodesis in days was 43 (IQR=69) and 23 (IQR=25), respectively. The overall rate of removal in the cohorts was 63% in non-MPE and 32% in MPE. Time to death in days was 253 (IQR=400) and 40 (IQR=97), respectively. Most patients with MPE died with their TPC in place, likely accounting for the lower rates of pleurodesis and rate of removal.
Conclusion: This study adds to the limited literature regarding TPC placement in non-MPE. Pleurodesis was accomplished in a minority of patients with non-MPE. Given survival is longer in patients with non-MPE than those with MPE, additional studies are required to determine costs, benefits and appropriate alternatives to TPC placement in this population.
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