Use of an Implantable Pleural Catheter for Trapped Lung Syndrome in Patients With Malignant Pleural Effusion

doi:10.1378/chest.119.6.1641

Chest

Volume 119, Issue 6, June 2001, Pages 1641-1646

https://doi.org/10.1378/chest.119.6.1641 Get rights and content

Study objectives

We describe a series of patients with symptomatic, refractory malignant pleural effusion (MPE) and underlying trapped lung syndrome who underwent placement of a small-bore, flexible indwelling pleural catheter for home drainage of recurrent MPE.

Design

The medical records of 11 consecutive patients who underwent pleural catheter placement for MPE with trapped lung syndrome were reviewed retrospectively.

Setting

Patients were evaluated and followed up in the Pulmonary Outpatient Practice at the Hospital of the University of Pennsylvania.

Patients

Nine men and two women with underlying malignancies including lung cancer, lymphoma, and mesothelioma underwent pleural catheter placement.

Interventions

Thirteen pleural catheters were placed in 11 patients, all under local anesthesia. Patients received detailed instructions for drainage and catheter care. They were reevaluated weekly for the first 2 weeks, and then as clinically indicated. Patients typically performed pleural drainage at home up to 1,000 mL two or three times weekly.

Measurements and results

All patients reported symptomatic benefit, defined as improved dyspnea and exercise tolerance, except for one patient. In 10 patients, the pleural catheters remained in place until death, for 15 to 234 days. The mean length of placement was 115 days. One patient required revision after catheter occlusion. Other complications included catheter infection, localized skin breakdown, and possible cellulitis.

Conclusion

We have described a series of patients with MPE and trapped lung syndrome for whom placement of a permanent pleural catheter provided a convenient, effective alternative to the procedures currently in use. Our patients reported good symptomatic relief following catheter placement with few major complications.

Section snippets

Patient Population

The charts and other medical records of 11 consecutive patients who underwent pleural catheter placement between July 1998 and December 1999 for recurrent MPE with trapped lung were reviewed retrospectively. All patients who underwent evaluation and subsequent pleural catheter placement for the indication of trapped lung at the Penn Lung Center have been included. Procedures were performed under the direction of the Director of Interventional Pulmonology at our institution. The patients

Results

Details of the patients and their course and survival are summarized in Table 1. Thirteen pleural catheters were placed in 11 patients: 1 patient had large bilateral effusions and underwent bilateral pleural catheter placement; another patient required catheter revision, described below. All patients tolerated implantation of the pleural catheter uneventfully. Frequency and volume of pleural fluid drainage varied widely from patient to patient, and over time in individual patients. All patients

Discussion

The term trapped lung describes persistent atelectasis with failure of the lung to reexpand following evacuation of a chronic pleural effusion. It most commonly results from the development of a fibrous peel over the visceral pleura, in the setting of chronic pleural inflammation. An ongoing malignant process in the pleural space may also produce a thick visceral pleural peel. The peel restricts expansion of the underlying lung parenchyma, generating higher negative pleural pressures within the

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Chest

Clinical InvestigationsCancerUse of an Implantable Pleural Catheter for Trapped Lung Syndrome in Patients With Malignant Pleural Effusion

Study objectives

Design

Setting

Patients

Interventions

Measurements and results

Conclusion

Section snippets

Patient Population

Results

Discussion

Clin Chest Med

Chest

Chest

Chest

Gynecol Oncol

Chest

Chest

Am J Med

Ann Thorac Surg

Chest

Diagnosis and treatment of malignant pleural effusion

Semin Oncol

Man agement of malignant pleural effusions

Semin Oncol

The treatment of malignant pleural effusions

Cancer

Pleurodesis: state of the art

Eur Respir J

Clinical Investigations
Cancer
Use of an Implantable Pleural Catheter for Trapped Lung Syndrome in Patients With Malignant Pleural Effusion