The use of the PleurX catheter in the management of non-malignant pleural effusions

Abstract

Purpose: To evaluate the effectiveness of the PleurX catheter in the management of recurrent non-malignant pleural effusions. Methods: All subjects who underwent a PleurX catheter placement between 2003 and 2009 were evaluated. General demographic data, time to pleurodesis, complications, and a satisfaction questionnaire were collected. The subjects were divided into two groups. Group I included patients with non-malignant effusions and group II included patients with malignant effusions. Results: A total of 64 subjects were included in the final data analysis. A total of 23 subjects were included in group I and 41 subjects were included in group II. The diagnoses in group I included congestive heart failure (CHF; 13), hepatic hydrothorax (8), traumatic bloody (1), and idiopathic exudative (1). The diagnoses in group II included lung cancer (20), breast cancer (11), colon cancer (5), prostate cancer (2), B-cell lymphoma (2), and mesothelioma (1). The time to pleurodesis was 36 + 12 days for group II compared to 110.8 + 41 days for group I (p < 0.0001). The mean satisfaction score was similar in both groups (3.8 + 0.4). Time to pleurodesis was significantly shorter in hepatic hydrothorax compared to CHF (73.6 + 9 days vs. 113 + 36 days, p ¼ 0.006). There was one case of exit site infection in a patient with hepatic hydrothorax. Among subjects who were alive at 3 months after the catheter removal, none had recurrence of their pleural effusion. Conclusion: The Denver catheter was effective in achieving pleurodesis in non-malignant pleural effusions. The complication rate was low and patient satisfaction was high.

The Use of a PleurX Catheter in the Management of Recurrent Benign Pleural Effusion: A Concise Review

“…A recurrent effusion is usually defined as repetitive fluid accumulation despite optimal medical management of the underlying condition. Those effusions are usually treated with multiple therapeutic thoracenteses prior to considering other options [5,6].…”

“…The mechanism by which the PleurX catheter achieves pleurodesis is not well understood. It is probably related to an inflammatory reaction that develops in response to a foreign object in the pleural space [6]. With the inflammatory reaction at the pleural surfaces and the repetitive suctioning that occurs during vacuum drainage resulting in pleural layers seal, spontaneous pleural symphysis occurs.…”

Indwelling Pleural Catheters

“…The typical way of recognising pleurodesis in those with IPCs is the repeated collection of small volumes of fluid (usually 50 ml or less on 3 consecutive occasions), although some authors have defined it differently [57,58]. Collated data suggest an overall spontaneous pleurodesis rate of around 45% for patients with MPE [25], however, some studies have reported significantly higher [59,60] or lower values [14,61]. This disparity highlights the important fact that patients with MPE tend to be an extremely heterogeneous group with regard to both fluid production and response to treatment.…”

“…Patient improvement, when reported, was of a similar level to that seen in MPE (94%) although the duration of the IPC being in situ was often longer, with an associated delay to spontaneous pleurodesis. Chalhoub et al [59] compared the outcome of a small cohort of patients with non-malignant IPCs to those with one with malignancy, demonstrating an average time to pleurodesis of over 3 months compared to just 36 days in the malignant group. Despite this potentially extended period of use, complications do not appear to occur significantly more often than in the malignant population, with an overall incidence of 11% and a specific empyema incidence of 5% [37]; this latter figure being confirmed by large series from both the US and the UK [ [11,85]].…”

Evidence-Based Review of the Management of Hepatic Hydrothorax

“…Chalhoub et al [95] studied the effectiveness of the PleurX catheter in the management of nonmalignant pleural effusions in a retrospective analysis of patients who underwent PleurX catheter placement for recurrent pleural effusions between 2003 and 2009. Patients were divided into two groups.…”