Pro: Indwelling Pleural Catheters Cause Harm to Patients

Overview

Journal Breathe (Sheff)

Specialty Pulmonary Medicine

Date 2024 Nov 13

PMID 39534486

Authors

Beenish Iqbal

Eihab Bedawi

Najib M Rahman

Affiliations

Soon will be listed here.

Abstract

Malignant pleural effusions (MPE) tend to recur and require definitive treatment with either chest drain and talc pleurodesis or indwelling pleural catheters (IPCs), which offer similar symptomatic benefits. In recent years, IPCs have become popular due to the presumed convenience of an outpatient procedure followed by home drainage leading to a misconception of IPCs being an ideal treatment for MPE. However, IPCs predispose the patient to multiple complications and have significant physical and psychological implications that are under-recognised. Patients require additional clinical reviews, hospital admissions and treatment for these complications related to IPCs. Additionally, there is a huge psychological impact of living with a home catheter that is a constant reminder of their cancer and this has been shown to affect quality of life negatively. Hence, IPCs should not be considered the "ideal" treatment for MPE management and clinicians should reflect the equipoise of the evidence for the benefits and accurately reflect the adverse effects of IPCs in their discussions with patients to facilitate informed decision making.

References

Bhatnagar R, Keenan E, Morley A, Kahan B, Stanton A, Haris M . Outpatient Talc Administration by Indwelling Pleural Catheter for Malignant Effusion. N Engl J Med. 2018; 378(14):1313-1322. DOI: 10.1056/NEJMoa1716883. View

Gilbert C, Wahidi M, Light R, Rivera M, Sterman D, Thomas R . Management of Indwelling Tunneled Pleural Catheters: A Modified Delphi Consensus Statement. Chest. 2020; 158(5):2221-2228. DOI: 10.1016/j.chest.2020.05.594. View

Davies H, Mishra E, Kahan B, Wrightson J, Stanton A, Guhan A . Effect of an indwelling pleural catheter vs chest tube and talc pleurodesis for relieving dyspnea in patients with malignant pleural effusion: the TIME2 randomized controlled trial. JAMA. 2012; 307(22):2383-9. DOI: 10.1001/jama.2012.5535. View

Mitchell M, Deschner E, Dhaliwal I, Robinson M, Li P, Kwok C . Patient perspectives on the use of indwelling pleural catheters in malignant pleural effusions. Thorax. 2023; 78(11):1111-1117. DOI: 10.1136/thorax-2022-219449. View

Muruganandan S, Azzopardi M, Fitzgerald D, Shrestha R, Kwan B, Lam D . Aggressive versus symptom-guided drainage of malignant pleural effusion via indwelling pleural catheters (AMPLE-2): an open-label randomised trial. Lancet Respir Med. 2018; 6(9):671-680. DOI: 10.1016/S2213-2600(18)30288-1. View

Sivakumar P, Fitzgerald D, Ip H, Rao D, West A, Noorzad F . The impact of outpatient inpatient management on health-related quality of life outcomes for patients with malignant pleural effusion: the OPTIMUM randomised clinical trial. Eur Respir J. 2023; 63(2). DOI: 10.1183/13993003.01215-2022. View

Wahidi M, Reddy C, Yarmus L, Feller-Kopman D, Musani A, Shepherd R . Randomized Trial of Pleural Fluid Drainage Frequency in Patients with Malignant Pleural Effusions. The ASAP Trial. Am J Respir Crit Care Med. 2016; 195(8):1050-1057. DOI: 10.1164/rccm.201607-1404OC. View

Aboudara M, Roller L, Lentz R, Rickman O, Gillaspie E, Maldonado F . A Survey-Based Study of Patient-Centered Costs Associated With Indwelling Pleural Catheters. Am J Hosp Palliat Care. 2020; 38(4):361-365. DOI: 10.1177/1049909120954810. View

Leff R, Eisenberg B, Baisden C, Mosley K, Messerschmidt G . Drainage of recurrent pleural effusion via an implanted port and intrapleural catheter. Ann Intern Med. 1986; 104(2):208-9. DOI: 10.7326/0003-4819-104-2-208. View

10.

Asciak R, Hallifax R, Mercer R, Hassan M, Wigston C, Wrightson J . The Hospital and Patient Burden of Indwelling Pleural Catheters: A Retrospective Case Series of 210 Indwelling Pleural Catheter Insertions. Respiration. 2018; 97(1):70-77. DOI: 10.1159/000491934. View

11.

Lau E, Faber S, Charlesworth C, Morey S, Vekaria S, Filion P . Topical antibiotics prophylaxis for infections of indwelling pleural/peritoneal catheters (TAP-IPC): A pilot study. Respirology. 2023; 29(2):176-182. DOI: 10.1111/resp.14595. View

12.

Thomas R, Fysh E, Smith N, Lee P, Kwan B, Yap E . Effect of an Indwelling Pleural Catheter vs Talc Pleurodesis on Hospitalization Days in Patients With Malignant Pleural Effusion: The AMPLE Randomized Clinical Trial. JAMA. 2017; 318(19):1903-1912. PMC: 5820726. DOI: 10.1001/jama.2017.17426. View

13.

Lui M, Thomas R, Lee Y . Complications of indwelling pleural catheter use and their management. BMJ Open Respir Res. 2016; 3(1):e000123. PMC: 4746457. DOI: 10.1136/bmjresp-2015-000123. View

14.

Tung A, Ngai J, Ng S, Ko F, Hui D . Early dislodgement of Indwelling Pleural Catheter (IPC): a balancing act. Respirol Case Rep. 2014; 2(1):13-4. PMC: 4184721. DOI: 10.1002/rcr2.33. View

15.

Putnam Jr J, Light R, Rodriguez R, Ponn R, Olak J, Pollak J . A randomized comparison of indwelling pleural catheter and doxycycline pleurodesis in the management of malignant pleural effusions. Cancer. 1999; 86(10):1992-9. View