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P172 Indwelling pleural catheter removal and auto-pleurodesis: predictors and outcome
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P172 Indwelling pleural catheter removal and auto-pleurodesis: predictors and outcome
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Journal Article
P172 Indwelling pleural catheter removal and auto-pleurodesis: predictors and outcome
2021
Overview
IntroductionIndwelling pleural catheters (IPC) provide definitive management of malignant pleural effusion. IPCs offer similar control of dyspnoea to talc pleurodesis without hospital admission but require ongoing management. Up to 47% of patients with IPC undergo auto-pleurodesis facilitating removal. Patient factors leading to this are not well understood.MethodsRetrospective analysis of IPC data at a UK tertiary centre between 2019–2021. Procedure reports, radiology, pathology and electronic patient records were reviewed to assess the most frequent diagnoses, imaging, and pleural fluid biochemistry leading to IPC removal. Outcomes and complications were analysed.Results115 patients underwent IPC insertion and 55 patients (47.8%) underwent IPC removal over the two year period. The median duration between insertion and removal was 97 days (IQR 62–133).Indications71% (39/55) of IPC removals were undertaken due to auto-pleurodesis, with other causes comprising of pain (3.6%; 2/55), blocked catheter (3.6%; 2/55) and non-draining, organised effusions (21.8%; 12/55).The most common primary malignancies associated with auto-pleurodesis included mesothelioma (31%, n=12), lung (18%, n=7), breast (18%, n=7).Lung-Sliding on Ultrasound Prior to IPC insertionOf the patients that underwent auto-pleurodesis, 24 had documentation pertaining to lung sliding on ultrasound. Lung sliding was present pre-insertion in 87.5% (21/24) and absent in 12.5% (3/24).Inflammatory-BiochemistryMedian pleural fluid LDH in patients with auto-pleurodesis was not significantly different vs baseline LDH in all patients with MPE (236.5IU/L auto-pleurodesis vs 326IU/L in all MPE, P>0.05, Mann-Witney).ComplicationsIPC removals resulted in few complications with retained catheter fragment (7.2%; 4/55) being the most reported. No patients required admission for a procedure related complication. Following IPC removal, 4 patients required further pleural aspiration and 3 re-insertion of IPC.Abstract P172 Figure 1a) Chart illustrating number of IPC insertions, removals and indications for removal; b) Chart illustrating number of patients with auto-pleurodesis with lung sliding on ultrasound prior to insertion of IPCConclusionsA significant proportion of patients with IPC undergo auto-pleurodesis. In this cohort of patients IPC removal presents a low risk of complications and offers significant benefits to patient comfort. The presence of lung sliding on ultrasound prior to insertion appears to be correlated with auto-pleurodesis, and this requires further investigation in larger prospective studies. The ability to give patients more information regarding likelihood of auto-pleurodesis could add to the decision making process for definitive fluid control.
Publisher
BMJ Publishing Group Ltd and British Thoracic Society,BMJ Publishing Group LTD
Subject
