Edema and Related Medical Conditions

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Tuesday, February 26, 2008

Treatment of Lung Edema (Pleural Effusions) with Pleur(x) Catheter

Management of malignant pleural effusions using the Pleur(x) catheter.

Ann Thorac Surg. 2008 Mar

Warren WH, Kalimi R, Khodadadian LM, Kim AW.
Department of Cardiovascular-Thoracic Surgery, Rush University Medical Center, Chicago, Illinois, USA.

BACKGROUND: A malignant pleural effusion can cause significant morbidity to terminal patients. Drainage and control of the fluid can provide great palliation. Improving the quality of life for these patients on an outpatient basis is a worthy goal.

METHODS: We have inserted 231 Pleur(x) (Cardinal Health Systems, McGaw Park, IL) catheters into 202 patients with symptomatic malignant pleural effusions with the goal of treating the fluid on an outpatient basis. The catheters were drained at home, using vacuum bottles, every other day after an initial week of draining daily. No sclerosing agents were instilled. The catheters were removed when drainage was less than 50 mL/day. Primary tumor sites, irradiation to the hemithorax, and incomplete re-expansion of the lung were studied for their ability to predict prolonged drainage (over 100 days).

RESULTS: In all cases, evacuation of the fluid with a Pleur(x) catheter palliated the patient's symptoms. Overall, 134 of 231 (58.0%) catheters were removed after the drainage tapered off. Reaccumulation of the pleural effusion occurred in 5 of 132 (3.8%) patients. The incidence of infection was 5 of 231 (2.2%) and was usually limited to cellulitis at the insertion site. The incidence of blockage was 11 of 231 (4.8%) and was most common in patients with an underlying cancer at sites other than breast and gynecologic primaries. Drainage for more than 100 days was seen most often in patients who had incomplete reexpansion of the underlying lung. Primary tumor site and irradiation did not have significant predictive value.

CONCLUSIONS: Insertion of Pleur(x) catheters is an effective way to treat patients with a malignant pleural effusion on an outpatient basis with a high degree of patient compliance and few complications. Overall, almost 60% of the catheters can be removed with a very low chance of reaccumulation, and without the need to instill a sclerosing agent. Even patients with a trapped lung can be palliated and released from hospital, although the likelihood of removing the catheter is small.

PMID: 18291195 [PubMed - in process]

Identification of clinical factors predicting Pleur(x)((R)) catheter removal in patients treated for malignant pleural effusion.

Eur J Cardiothorac Surg. 2008 Jan

Warren WH, Kim AW, Liptay MJ.
Department of Cardiovascular-Thoracic Surgery, Rush University Medical Center, Chicago, IL 60612, USA.

Objective: The objective of the study was to review the clinical records of patients undergoing insertion of a Pleur(x)((R)) catheter in the management of malignant pleural effusions. In particular, clinical parameters were analyzed for their influence on catheter removeability.

Methods: Between January 1998 and July 2006, 263 patients underwent insertion of 295 Pleur(x)((R)) catheters for malignant pleural effusion(s). Patients were allocated to one of four groups based upon the site of the primary tumor: group 1 (breast), group 2 (lung), group 3 (gynecologic), and group 4 (all others). A history of prior chest irradiation, cytologic analysis (positive or negative for malignant cells), and incidence of trapped lung were also studied to determine if, in addition to the primary site, these influenced the incidence of pleurodesis.

Results: Overall, 58.6% of Pleur(x)((R)) catheters were removed prior to death. The incidence of spontaneous symphysis and catheter removal in groups 1 (69.6%) and 3 (72.5%) was significantly higher than in groups 2 and 4 (p<0.001).>

Conclusions: Pleur(x)((R)) catheters effectively relieve patients of dyspnea by evacuating the pleural space. Spontaneous pleural symphysis and catheter removal is more likely in patients with breast or gynecologic primary tumors, absence of chest wall irradiation, cytologic positivity, and complete re-expansion of the underlying lung.


Surgical and other invasive approaches to recurrent pleural effusion with malignant etiology.

Support Care Cancer. 2008 Feb 8

Neragi-Miandoab S.
Department of Surgery, School of Medicine, Case Western Reserve University, 11100 Euclid Ave. LKS 7109, Cleveland, OH, USA,

With an increasing number of cancer survivors, the annual incidence of malignant pleural effusions has been rising in recent decades worldwide. Many patients with various forms of cancer develop malignant pleural effusions at some point in their life. Patients most commonly present with progressive dyspnea. These effusions are refractory and are associated with impaired quality of life for these patients. The main goals of management are evacuation of the pleural fluid and prevention of its re-accumulation. The therapy plan should consider the general health of the patients, their performance status, the presence of trapped lung, and the primary malignancy. However, there is no universally established, standard approach. Surgical options include thoracentesis, chest tube drainage, thoracoscopy followed by chemical and mechanical pleurodesis, Pleur-X catheter drainage, and pleurectomy. Chemical pleurodesis is the most common modality of therapy for patients with recurrent pleural effusion. For example, Talc is the most successful pleurodesis agent with similar equal to that of poudrage or slurry. Pleur-X catheter can reduce hospital stay and adds value to the treatment of patients with trapped lung, who are not appropriate candidates for pleurodesis. Furthermore, a mechanical pleurodesis has been shown to be effective particularly in pleural effusions with lower pH. This article reviews the surgical and other invasive options as well as their technical aspects in the management of recurrent malignant pleural effusions.