Management of Malignant Pleural Effusion Associated with Trapped Lung Syndrome

Abstract

Management of recurrent malignant pleural effusion associated with trapped lung syndrome remains problematic. An alternative treatment using a pleural catheter has been advocated. Between August 1999 and August 2002, 127 patients underwent thoracoscopy for malignant pleural effusion. Of these, 52 (41%) with trapped lung were managed by insertion of a pleural catheter. Mean age was 66 years (range, 42-89 years). The most frequent diagnosis was breast cancer. Spontaneous pleurodesis (drainage < 10 mL) occurred in 25 (48%) patients whose catheter was removed after 30 to 255 days (mean, 93.8 days). Symptomatic relief was achieved in 49 (94%) patients. Mean dyspnea score improved significantly from 3.0 to 1.9. Complications comprised catheter blockage, surgical emphysema, cellulitis, and loculated effusion in 2 patients each. Mean length of hospital stay was 3 days (range, 1-16 days). Median survival was 126 days (range, 10-175 days). We conclude that long-term placement of a pleural catheter provides effective palliation for malignant pleural effusion associated with trapped lung syndrome.

Advanced medical interventions in pleural disease

“…Patients and carers are empowered, therefore, to manage their recurrent collections at home and, in many cases, can avoid or significantly reduce hospital admissions [51][52][53]. Initially recommended for the management of those patients who had failed pleurodesis [12,54] or those in whom trapped lung was the primary pathology [14,55,56], recent years have seen a shift in many centres towards an alternative paradigm, one in which IPCs are viewed as a valid first-line alternative to chemical sclerosant therapy [57,58]. This idea was cemented by the publication of the TIME2 study, a multicentre RCT comparing standard chest drain and talc pleurodesis to IPC for the management of MPE.…”

Indwelling Pleural Catheters

“…Larger or unexpected collections of air should prompt consideration of underlying visceral damage and may warrant an extended period of observation before discharge. Instances of subcutaneous emphysema have also been documented, although many have occurred when an IPC is inserted at the same time as a video-assisted thoracic surgery (VATS) [23]. This demonstrates another reason why careful consideration should be given to track length, as if it is made too long there is the possibility of a fenestration remaining in the extrapleural space.…”

Management options for the complicated pleural space

“…Palliative surgical decortication is not recommended for this patient population because it requires prolonged hospitalization, and morbidity and mortality are high [45,46]. Indwelling pleural catheters have been shown to provide symptom relief for 48-94 % of patients with MPE with trapped lung [47][48][49]. Despite the trapped lung, indwelling pleural catheters induced spontaneous pleurodesis in 48 % of patients after a mean of 94 days [49].…”

“…Indwelling pleural catheters have been shown to provide symptom relief for 48-94 % of patients with MPE with trapped lung [47][48][49]. Despite the trapped lung, indwelling pleural catheters induced spontaneous pleurodesis in 48 % of patients after a mean of 94 days [49]. Complications such as air leak, catheter occlusion, cellulitis, and development of loculations may occur in up to 15 % of patients [49].…”

“…Despite the trapped lung, indwelling pleural catheters induced spontaneous pleurodesis in 48 % of patients after a mean of 94 days [49]. Complications such as air leak, catheter occlusion, cellulitis, and development of loculations may occur in up to 15 % of patients [49]. In addition, indwelling pleural catheters provide minimally invasive palliation for patients with late-stage malignancies.…”