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Chest. 2012 Aug;142(2):394-400. doi: 10.1378/chest.11-2657.

Indwelling pleural catheters reduce inpatient days over pleurodesis for malignant pleural effusion.

Author information

1
Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth; Centre for Asthma, Allergy, and Respiratory Research, University of Western Australia, Perth; School of Medicine and Pharmacology, University of Western Australia, Perth.
2
School of Medicine and Pharmacology, University of Western Australia, Perth; Department of Respiratory Medicine, Royal Perth Hospital, Perth.
3
School of Medicine and Pharmacology, University of Western Australia, Perth; Department of Respiratory Medicine, Fremantle Hospital, Fremantle, WA, Australia.
4
Department of Respiratory Medicine, Fremantle Hospital, Fremantle, WA, Australia.
5
School of Population Health, University of Western Australia, Perth.
6
Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth.
7
Department of Medical Oncology, Sir Charles Gairdner Hospital, Perth; School of Medicine and Pharmacology, University of Western Australia, Perth.
8
Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth; School of Population Health, University of Western Australia, Perth.
9
Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth; Centre for Asthma, Allergy, and Respiratory Research, University of Western Australia, Perth; School of Medicine and Pharmacology, University of Western Australia, Perth. Electronic address: gary.lee@uwa.edu.au.

Abstract

BACKGROUND:

Patients with malignant pleural effusion (MPE) have limited prognoses. They require long-lasting symptom relief with minimal hospitalization. Indwelling pleural catheters (IPCs) and talc pleurodesis are approved treatments for MPE. Establishing the implications of IPC and talc pleurodesis on subsequent hospital stay will influence patient choice of treatment. Therefore, our objective was to compare patients with MPE treated with IPC vs pleurodesis in terms of hospital bed days (from procedure to death or end of follow-up) and safety.

METHODS:

In this prospective, 12-month, multicenter study, patients with MPE were treated with IPC or talc pleurodesis, based on patient choice. Key end points were hospital bed days from procedure to death (total and effusion-related). Complications, including infection and protein depletion, were monitored longitudinally.

RESULTS:

One hundred sixty patients with MPE were recruited, and 65 required definitive fluid control; 34 chose IPCs and 31 pleurodesis. Total hospital bed days (from any causes) were significantly fewer in patients with IPCs (median, 6.5 days; interquartile range [IQR] = 3.75-13.0 vs pleurodesis, mean, 18.0; IQR, 8.0-26.0; P = .002). Effusion-related hospital bed days were significantly fewer with IPCs (median, 3.0 days; IQR, 1.8-8.3 vs pleurodesis, median, 10.0 days; IQR, 6.0-18.0; P < .001). Patients with IPCs spent significantly fewer of their remaining days of life in hospital (8.0% vs 11.2%, P < .001, χ(2) = 28.25). Fewer patients with IPCs required further pleural procedures (13.5% vs 32.3% in pleurodesis group). There was no difference in rates of pleural infection (P = .68) and protein (P = .65) or albumin loss (P = .22). More patients treated with IPC reported immediate (within 7 days) improvements in quality of life and dyspnea.

CONCLUSIONS:

Patients treated with IPCs required significantly fewer days in hospital and fewer additional pleural procedures than those who received pleurodesis. Safety profiles and symptom control were comparable.

PMID:
22406960
DOI:
10.1378/chest.11-2657
[Indexed for MEDLINE]

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