Randomized Trial of Pleural Fluid Drainage Frequency in Patients with Malignant Pleural Effusions. The ASAP Trial

Wahidi, Momen M.; Reddy, Chakravarthy; Yarmus, Lonny; Feller‐Kopman, David; Musani, Ali I.; Shepherd, Ray W.; Lee, Hans C.; Bechara, Rabih; Lamb, Carla; Shofer, Scott; Mahmood, Kamran; Michaud, Gaëtane; Puchalski, Jonathan; Rafeq, Samaan; Cattaneo, Stephen M.; Mullon, John J.; Leh, Steven; Mayse, Martin L.; Thomas, Samantha; Peterson, Bercedis L.; Light, Richard W.

doi:10.1164/rccm.201607-1404oc

Cited by 212 publications

(148 citation statements)

References 19 publications

Supporting

Mentioning

135

Contrasting

Unclassified

Order By: Relevance

“…However, our results show a lower rate of removal due to IPC-related spontaneous pleurodesis (32.2% overall: 33.1% in MPE group, 23.8% in non-MPE group) in line with the placebo arm of the ASAP trial which reported 24% rate of IPC-related spontaneous pleurodesis with standard IPC drainage [7]. Excluding patients with evidence of pleural infection at the time of IPC insertion, our results demonstrate significant infection rates of 8.6% (6.6% for pleural infections, 3.0% for soft tissue infections) over the period of follow-up, occurring late.…”

Section: Discussionsupporting

confidence: 79%

The Hospital and Patient Burden of Indwelling Pleural Catheters: A Retrospective Case Series of 210 Indwelling Pleural Catheter Insertions

et al. 2018

View full text Add to dashboard Cite

Background: Indwelling pleural catheters (IPC) offer an alternative to talc pleurodesis in recurrent effusion, especially in patients wishing to avoid hospitalization. Two randomized trials have demonstrated reduced time in hospital using IPCs versus talc pleurodesis in malignant pleural effusion (MPE). However, the impact of IPCs on hospital services and patients has not been well studied. Objectives: To analyze long-term outcomes of IPCs and understand the hospital burden in terms of requirement for hospital visits and contacts with healthcare, while the IPC was in situ. Methods: IPC insertions in a tertiary pleural center were analyzed retrospectively. Reviews of patients with IPCs in situ considered “additional” to routine clinical follow-up were defined pre-hoc. Results: A total of 202 cases were analyzed: 89.6% MPE group (n = 181) and 10.4% non-MPE group (n = 21). There were a median 3.0 (interquartile range [IQR] 3) and 2.0 (IQR 2) ipsilateral pleural procedures prior to each IPC insertion in non-MPE and MPE groups, respectively (p = 0.26), and a mean 1.3 (SD 1.7) planned IPC-related outpatient follow-up visits per patient. There were 2 (9.5%) and 14 (7.7%) IPC-related infections in non-MPE and MPE groups, respectively. Four (19.0%) and 44 (24.3%) patients required additional IPC-related reviews in non-MPE and MPE groups, respectively (p = 0.6), and these occurred within 250 days post IPC insertion. Conclusions: Although IPCs decrease initial length of hospital stay compared to talc pleurodesis via chest drain, IPCs are associated with significant hospital-visit burden, in addition to planned visits and regular home IPC drainages. IPC-using services need to be prepared for this additional work to run an IPC service effectively.

show abstract

Section: Discussionsupporting

confidence: 79%

The Hospital and Patient Burden of Indwelling Pleural Catheters: A Retrospective Case Series of 210 Indwelling Pleural Catheter Insertions

et al. 2018

View full text Add to dashboard Cite

show abstract

“…In a recent randomized trial, Impact of Aggressive versus Standard Drainage Regimen Using a Long-Term Indwelling Pleural Catheter trial (ASAP trial), rates of spontaneous pleurodesis were higher in patients daily drainage compared to the every other day drainage of pleural fluid via a TPC (47% vs. 24%, respectively; P = 0.003). Median time to spontaneous pleurodesis was shorter in the daily drainage group (54 days) as compared with the every other day drainage (90 days) (80).…”

Section: Tunneled Pleural Catheter (Tpc)mentioning

confidence: 83%

Diagnosis and management of malignant pleural effusions: state of the art in 2017

Desai

Lee

2017

J. Thorac. Dis.

View full text Add to dashboard Cite

Malignant pleural effusion (MPE) is a known complication of both thoracic and extra thoracic malignancies. The presence of MPE regardless of the primary site translates into advanced stage disease.Diagnosis and management of MPE with the goals of palliation and improving quality of life poses a challenge for chest physicians. Recently, multiple studies have made attempts to answer questions regarding optimal management in various clinical scenarios. We will review the current evidence and available options for the management of MPE.

show abstract

“…Drainages and dressing changes were completed by nurses who have been trained on proper catheter care. When drainage quantity was decreased to less than 50 mL for 3 sequential drainage attempts, without evidence of reaccumulation of pleural fluid on chest X-ray, spontaneous pleurodesis was considered to have occurred and the IPC was removed [12,13,15].…”

Section: Methodsmentioning

confidence: 99%

“…Collected data have traditionally shown an overall rate of spontaneous pleurodesis and IPC removal of around 45% [13,14], although more recently published randomized control trial have demonstrated a rate of spontaneous pleurodesis closer to 25% in the control groups [12,15]. Identifying who will ultimately have their catheter removed is important from the perspective of the patient inquiring about IPC placement.…”

Section: For Editorial Comment See P 497mentioning

confidence: 99%

Effect of Chemotherapy on Removal of Indwelling Pleural Catheters in Breast Cancer Patients with Malignant Pleural Effusions

et al. 2018

View full text Add to dashboard Cite

Background: Indwelling pleural catheters (IPC) are commonly used in the management of malignant pleural effusions (MPE). The effect of systemic chemotherapy on IPC removal has not been reported previously. Objectives: The purpose of this study is to identify the effect of chemotherapy on the removal of IPCs in breast cancer patients with MPEs. Methods: In this retrospective cohort study at an academic tertiary-care center, patients with breast cancer and MPE who received an IPC between 2006 and 2016 were identified from a prospectively collected database. Patient chemotherapy data were obtained, as well estrogen receptor (ER) and human epidermal growth factor receptor-2 status at the time of diagnosis. Patients receiving chemotherapy while their IPC was in situ were compared to those who did not. The primary outcome was time to IPC removal. All patients were followed until IPC removal or death. Results: A total of 207 patients and 216 IPCs were included in the analysis. There was no difference in time to IPC removal between the chemotherapy and no-chemotherapy groups (HR 0.73, 95% CI 0.50–1.07, p = 0.10) or rate of IPC removal (OR 1.16, 95% CI 0.68–1.98, p = 0.59). The risk of IPC infection was not different between patients who received chemotherapy and those who did not (RR 0.57, 95% CI 0.06–5.39, p = 0.48). Conclusions: Treatment with chemotherapy with an IPC in situ was not associated with a reduced time to IPC removal in our breast cancer population. IPC insertion in patients receiving chemotherapy is safe and not associated with an increased risk of infection.

show abstract

Randomized Trial of Pleural Fluid Drainage Frequency in Patients with Malignant Pleural Effusions. The ASAP Trial

Abstract: Among patients with malignant pleural effusion, daily drainage of pleural fluid via an indwelling pleural catheter led to a higher rate of autopleurodesis and faster time to liberty from catheter. Clinical trial registered with www.clinicaltrials.gov (NCT 00978939).

Cited by 212 publications

References 19 publications

The Hospital and Patient Burden of Indwelling Pleural Catheters: A Retrospective Case Series of 210 Indwelling Pleural Catheter Insertions

The Hospital and Patient Burden of Indwelling Pleural Catheters: A Retrospective Case Series of 210 Indwelling Pleural Catheter Insertions

Diagnosis and management of malignant pleural effusions: state of the art in 2017

Effect of Chemotherapy on Removal of Indwelling Pleural Catheters in Breast Cancer Patients with Malignant Pleural Effusions

Contact Info

Product

Resources

About