Chest
Volume 142, Issue 2, August 2012, Pages 394-400
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Original Research
Pulmonary Procedures
Indwelling Pleural Catheters Reduce Inpatient Days Over Pleurodesis for Malignant Pleural Effusion

https://doi.org/10.1378/chest.11-2657Get rights and content

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, χ2 = 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.

Section snippets

Materials and Methods

This study forms part of the analyses of the Western Australian study of Malignant Pleural Effusion, approved by the Human Research Ethics Committees of the Sir Charles Gairdner, Fremantle, and Royal Perth Hospitals in Western Australia, and the University of Western Australia (approval number 2009-104). All patients provided written, informed consent.

Patients with MPE from the three major public teaching hospitals in Perth, Western Australia (population about 1.7 million) were recruited over

Baseline Demographics

Of the 160 patients with MPE enrolled, 65 had symptomatic and, in most cases, recurrent effusions that required definitive treatment. Thirty-four patients elected to be treated with an IPC and 31 with talc pleurodesis. The two groups were similar in their baseline characteristics (Table 1).

IPCs were inserted by the respiratory (n = 30), radiology (n = 3), and cardiothoracic (n = 1) services. As expected, more patients in the IPC group had incomplete lung re-expansion after initial drainage,

Discussion

This study confirmed in a prospective, pragmatic, patient-choice setting that the use of IPC significantly reduced the number of hospital bed days for patients with an MPE that required definitive treatment. The nonrandomized, patient-centered design whereby patients and clinicians were allowed to tailor therapy to individual circumstances replicated real-life settings. A median reduction of 11.5 hospital bed days is significant for these patients with limited life spans and can represent

Acknowledgments

Author contributions: Dr Lee is guarantor of the study.

Dr Fysh: contributed to study conception and design, data collection and patient care, manuscript drafting and revision, and final approval of the manuscript.

Dr Waterer: contributed to study conception and design, manuscript drafting and revision, and final approval of the manuscript.

Dr Kendall: contributed to study conception and design, manuscript drafting and revision, and final approval of the manuscript.

Dr Bremner: contributed to data

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    Funding/Support: This project was funded by a grant from the State Health Research Advisory Council of the Western Australian Health Department and from the Sir Charles Gairdner Research Foundation. Dr Fysh receives scholarships from the National Health and Medical Research Council and the Lung Institute of Western Australia.

    Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.

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