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Chest. 2015 Sep;148(3):752-758. doi: 10.1378/chest.14-3119.

The Use of Indwelling Tunneled Pleural Catheters for Recurrent Pleural Effusions in Patients With Hematologic Malignancies: A Multicenter Study.

Author information

1
Division of Pulmonary, Allergy, and Critical Care Medicine, Bronchoscopy and Interventional Pulmonology, Penn State College of Medicine-Milton S. Hershey Medical Center, Hershey, PA. Electronic address: cgilbert1@hmc.psu.edu.
2
Division of Pulmonary and Critical Care Medicine, Interventional Pulmonary, The Johns Hopkins University School of Medicine, Baltimore, MD.
3
Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN.
4
Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University Medical Center, Durham, NC.
5
Division of Pulmonary, Allergy, and Critical Care Medicine, Interventional Pulmonology and Thoracic Oncology, University of Pennsylvania Medical Center, Philadelphia, PA.
6
Division of Pulmonary, Allergy, and Critical Care Medicine, Emory University Medical Center, Atlanta, GA.
7
Division of Pulmonary and Critical Care Medicine, Section of Interventional Pulmonology, Virginia Commonwealth University Medical Center, Richmond, VA.
8
Division of Thoracic Surgery and Interventional Pulmonology, Swedish Cancer Institute, Seattle, WA.
9
Department of Biostatistics, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.

Abstract

BACKGROUND:

Malignant pleural effusion is a common complication of advanced malignancies. Indwelling tunneled pleural catheter (IPC) placement provides effective palliation but can be associated with complications, including infection. In particular, hematologic malignancy and the associated immunosuppressive treatment regimens may increase infectious complications. This study aimed to review outcomes in patients with hematologic malignancy undergoing IPC placement.

METHODS:

A retrospective multicenter study of IPCs placed in patients with hematologic malignancy from January 2009 to December 2013 was performed. Inclusion criteria were recurrent, symptomatic pleural effusion and an underlying diagnosis of hematologic malignancy. Records were reviewed for patient demographics, operative reports, and pathology, cytology, and microbiology reports.

RESULTS:

Ninety-one patients (mean ± SD age, 65.4 ± 15.4 years) were identified from eight institutions. The mean × SD in situ dwell time of all catheters was 89.9 ± 127.1 days (total, 8,160 catheter-days). Seven infectious complications were identified, all of the pleural space. All patients were admitted to the hospital for treatment, with four requiring additional pleural procedures. Two patients died of septic shock related to pleural infection.

CONCLUSIONS:

We present, to our knowledge, the largest study examining clinical outcomes related to IPC placement in patients with hematologic malignancy. An overall 7.7% infection risk and 2.2% mortality were identified, similar to previously reported studies, despite the significant immunosuppression and pancytopenia often present in this population. IPC placement appears to remain a reasonable clinical option for patients with recurrent pleural effusions related to hematologic malignancy.

PMID:
25789576
PMCID:
PMC4556125
DOI:
10.1378/chest.14-3119
[Indexed for MEDLINE]
Free PMC Article

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