Indwelling pleural catheters for the treatment of malignant pleural effusions; where are we now?

Abstract

Introduction: Malignant pleural effusions (MPE) affect many patients with advanced malignant disease and lead to significant symptomatic burden. Management is primarily focused on controlling symptoms. IPCs are considered an alternative treatment strategy to chemical pleurodesis and in randomized clinical trials, are shown to have comparable outcomes with regards to symptom management such as dyspnea score and quality of life, and are associated with shorter length of hospital stay. Additional studies have examined the optimal drainage strategy for IPCs and the combination of IPC and pleurodesis. The most common complication is infection, and management differs based on the specific infection type. For many patients, IPCs are likely a cost-effective option for management of MPE compared to alternative approaches.

Areas covered: This review article details the role of the indwelling pleural catheter (IPC) for symptom control, strategies for management, removal, complications, cost-effectiveness, and future directions.

Expert opinion: There are various management options for MPE, each with their own advantages and disadvantages. Management should be personalized, with full knowledge of the patient's life expectancy, pleural space physiology, risks and benefits of each approach, and most importantly patient preferences.