Background: Tunnelled pleural catheters used to treat malignant pleural effusions may achieve pleurodesis. We aimed to identify factors associated with higher pleurodesis rates and earlier catheter removal.
Methods: We retrospectively reviewed a prospective database of tunnelled pleural catheters inserted consecutively between May 2006 and June 2013 for confirmed malignant pleural effusion. The cohort included patients who underwent medical thoracoscopy. Clinical, radiologic and pleural fluid data were recorded. We used logistic regression and Cox regression to assess rates of and days to pleurodesis, respectively.
Results: We analyzed data for 1071 tunnelled pleural catheters in 956 patients. Increased rates of pleurodesis were associated with lymphoma (odds ratio [OR] 3.49, 95% confidence interval [CI] 1.93-6.33), ovarian cancer (OR 2.93, 95% CI 1.68-5.11), Eastern Cooperative Oncology Group Scale of Performance Status grade 2 or less (OR 2.79, 95% CI 1.79-4.34), medical thoracoscopy (OR 2.21, 95% CI 1.28-3.85), protein level (OR 1.03, 95% CI 1.01-1.06), albumin level (OR 1.07, 95% CI 1.03-1.12) and percent eosinophils (OR 1.04, 95% CI 1.00-1.07). Reduced rates of pleurodesis were associated with gastrointestinal cancers (OR 0.41, 95% CI 0.19-0.87), hydropneumothorax on the postdrainage chest radiograph (OR 0.62, 95% CI 0.41-0.94) and percent other cells on cell count (OR 0.98, 95% CI 0.97-0.99). Earlier pleurodesis was associated with ovarian cancer (hazard ratio [HR] 1.48, 95% CI 1.06-2.08), medical thoracoscopy (HR 1.45, 95% CI 1.10-1.92), protein level (HR 1.03, 95% CI 1.01-1.04) and percent eosinophils (HR 1.02, 95% CI 1.00-1.04). Delayed pleurodesis was associated with breast cancer (HR 0.61, 95% CI 0.46-0.81), hydropneumothorax with 80% or less lung expansion (HR 0.55, 95% CI 0.38-0.80) and percent other cells (HR 0.99, 95% CI 0.98-1.00).
Interpretation: Clinicians should consider numerous factors to predict the probability of and timing to pleurodesis with tunnelled pleural catheters.
Download full-text PDF |
Source |
|---|---|
| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7868087 | PMC |
| http://dx.doi.org/10.9778/cmajo.20170163 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Introduction: Malignant Pleural Effusion (MPE) is common in advanced malignancy. Data are needed on health care utilization and costs.
Methods: This population-based retrospective cohort study included patients aged ≥18 years with an MPE diagnosed between January 1, 2004 and December 31, 2018.
Tunneled Pleural Catheters: An Effective Nonsurgical Alternative for Nonexpandable Lung in Chronic Pleural Infection.
J Bronchology Interv Pulmonol
January 2025
Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Harvard Medical School.
Background: Open window thoracostomy (OTW) is the standard of care for debilitated patients with chronic pleural infection and nonexpandable lungs (NEL) who are not candidates for major surgical intervention. Tunneled pleural catheters (TPC) offer tremendous treatment potential in this setting based on their efficacy in malignant pleural effusion and NEL. We aim to assess the efficacy, safety, and health care utilization of TPC in this setting.
View Article and Find Full Text PDFTunneled Pleural Catheter and Endobronchial Valves for Spontaneous Pneumothorax Complicated by Persistent Air Leak and Empyema.
Ann Am Thorac Soc
November 2024
Division of Thoracic Surgery and Interventional Pulmonology, Department of Surgery, and.
Surgical management of pleural complications in lymphangioleiomyomatosis.
J Thorac Cardiovasc Surg
August 2024
Center for LAM and Rare Lung Diseases at Columbia University, Department of Anesthesiology, Columbia University Irving Medical Center, New York, NY. Electronic address:
Article Synopsis
- Lymphangioleiomyomatosis (LAM) is a rare lung disease mostly affecting women, often leading to complications like pneumothorax and chylothorax, so surgical management options were examined.
- The study reviewed records of 326 patients suspected of having LAM, revealing that 40.5% underwent surgical procedures, with significant instances of pneumothorax and associated treatments like pleurodesis.
- Findings suggest a high occurrence of pleural disease in LAM patients, indicating a need for thoracic surgeons to be aware of these issues and highlighting the potential benefits of using tunneled indwelling pleural catheters for better management.
Intrapleural Migration of Ventriculoperitoneal Shunt due to Negative Intrathoracic Pressure.
Asian J Neurosurg
September 2024
Department of Neurosurgery, Kasturba Medical College and Hospital, Udupi, Karnataka, India.
Article Synopsis
- VP shunts are commonly used to treat infants with aqueductal stenosis, but shunt migration can occur, including rare cases of migration into the thoracic cavity due to negative pressure.* -
- A one-year-old infant with symptoms of raised intracranial pressure underwent emergency VP shunt placement, which initially went well but later resulted in acute breathing issues due to the shunt migrating into the pleural space.* -
- Imaging showed that the shunt likely tunneled improperly during the first surgery, leading to its eventual migration over three months, necessitating an emergency revision to address the issue.*
Want AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!