The Authors: Paul MacEachern, MD, FRCPC, FCCP, is an Interventional Pulmonologist at the University of Calgary with research interests in the treatment of malignant pleural disease as well as diagnostic and therapeutic bronchoscopy. Alain Tremblay, MDCM, FRCPC, FCCP, is Director of the Interventional Pulmonary Medicine Program at the University of Calgary and his areas of research include treatment of malignant pleural disease as well as diagnostic and therapeutic bronchoscopy.
Pleural controversy: Pleurodesis versus indwelling pleural catheters for malignant effusions
Article first published online: 28 JUN 2011
© 2011 The Authors; Respirology © 2011 Asian Pacific Society of Respirology
Volume 16, Issue 5, pages 747–754, July 2011
How to Cite
MACEACHERN, P. and TREMBLAY, A. (2011), Pleural controversy: Pleurodesis versus indwelling pleural catheters for malignant effusions. Respirology, 16: 747–754. doi: 10.1111/j.1440-1843.2011.01986.x
Conflict of Interest Statement: Dr Tremblay has a patent pending on a method of delivery of sclerosing agents to the pleural space for pleurodesis. The University of Calgary has received funds for contract research from CareFusion Inc.
- Issue published online: 28 JUN 2011
- Article first published online: 28 JUN 2011
- Accepted manuscript online: 4 MAY 2011 05:54AM EST
- Received 25 March 2011; accepted 14 April 2011.
- indwelling pleural catheters;
- malignant pleural effusion;
Malignant pleural effusions (MPE) are a common complication of advanced malignancy. The treatment of MPE should be focused on palliation of associated symptoms. The traditional approach to MPE has been to attempt pleurodesis by introducing a sclerosant into the pleural space. A more recent development in the treatment of MPE has been the use of indwelling pleural catheters (IPC) for ongoing drainage of the pleural space. Controversy exists as to which approach is superior. Pleurodesis approaches will have the advantage of a time-limited course of treatment and high pleurodesis rate at the cost of a more invasive procedure requiring a general anaesthetic or conscious sedation (for thoracoscopic approaches) and an inpatient hospital stay. Use of IPC will allow the patient to be treated on an outpatient basis with a minimally invasive procedure, at the cost of long-term need for catheter drainage and care. Symptom control appears similar between techniques. Complication rates between the two approaches cannot be easily compared, but studies suggest more frequent severe complications such as respiratory failure, arrhythmias and even mortality following pleurodesis, with infection rates similar between the two approaches. IPC will likely see increasing utilization in the future but patient preference and local resources and expertise will continue to play a significant part in treatment decisions. Randomized trials directly comparing the two approaches are needed and some are underway. Novel combination approaches utilizing both IPC and pleurodesis agents have the potential to further improve the care of these patients.