Nutzen und Sicherheit der Behandlung von Pleuraergüssen mit dem PleurX-Katheter: eine retrospektive Analyse

Abstract

! Background:The purpose of this retrospective study was to investigate the efficacy and safety of an indwelling pleural device (PleurX, Denver Biomedical, USA) for the treatment of recurrent pleural effusions. In cases when life expectancy tends to be very short and also surgical decortication is not recommended, pleurodesis is another treatment option but requires complete drainage of the whole pleural fluid for optimal results which is sometimes hard to achieve. The PleurX catheter is an alternative therapeutic option. Methods and Results: We retrospectively analysed the clinical data from a total of 21 patients who were treated with a PleurX alone (11 patients) or who initially received pleurodesis and afterwards a PleurX catheter (10 patients). Mean survival was 25 weeks after initial diagnosis of the underlying disease. The mean amount of pleural effusion drained per week was 725 mL. 16 patients used the catheter until they died at least 1 -2 times a week. The complication rate was 19 % and thus within a reasonable range when compared to other treatment options for recurrent pleural effusions. There was no statistically significant difference in clinical outcome in both groups (pleurodesis and subsequent PleurX vs. PleurX alone). The amount of evacuated pleural effusion was inversely correlated with the remaining life time. Conclusion: The use of an indwelling pleural device is a safe alternative treatment option for patients with chronic pleural effusions and trapped lung signs. We should be aware of this device and propagate its use at an earlier stage of malignant diseases with recurrent pleural effusions, especially when the remaining life time is short.

The Malpositioned Tunneled Pleural Catheter

“…In addition to having the advantage of decreased hospital stay,3,4 they have been shown to have similar, if not better, safety profile than pleurodesis,3,5,6 higher success rate with achieving pleural drainage and lesser time to symptom improvement 7. It is also preferred over pleurodesis in patients with MPE and poor performance status and poor prognosis, as well as in patients with trapped lung 3…”

Experience with indwelling pleural catheters in the treatment of recurrent pleural effusions

“…Since its FDA approval in 1997, the IPC became the preferred method for managing recurrent MPEs on an outpatient basis [ Brubacher and Gobel, 2003 ]. Different studies have shown that it is at least as effective as chest tube and chemical pleurodesis in controlling MPEs [ Putnam et al 1999 , Blaukovitsch et al 2011 ], and that it is the preferred method to treat MPEs associated with trapped lung [ Efthymiou et al. 2009 ].…”