Indwelling pleural catheter versus pleurodesis for malignant pleural effusions a systematic review and meta-analysis

Narayan P. Iyer, Chakravarthy B. Reddy, Momen M. Wahidi, Sandra Z. Lewis, Rebecca L. Diekemper, David Feller-Kopman, Michael K. Gould, Alex A. Balekian

Research output: Contribution to journalReview article

Abstract

Rationale: Several randomized trials have compared the efficacy of an indwelling pleural catheter (IPC) versus the more traditional chemical pleurodesis in the management of malignant pleural effusion (MPE). Objectives: As part of the American Thoracic Society’s guidelines for management of MPE, we performed a systematic review and a meta-analysis to compare patient-centered outcomes with the use of a tunneled pleural catheter versus chemical pleurodesis for the first-line treatment of malignant pleural effusions. Methods: We performed literature searches in MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials. We included randomized controlled trials comparing IPC and pleurodesis in adult patients with symptomatic MPE. Risk of bias was assessed with the Cochrane Risk of Bias tool recommended by the Cochrane Methods Bias Group. The meta-analysis was performed with Review Manager software, using a random effects model. We used risk ratios (RRs) with 95% confidence interval (CI) as the effect measure for dichotomous outcomes and mean differences for continuous outcomes. Results: We identified five randomized trials, involving 545 patients, that compared IPC and pleurodesis. Lack of blinding and the inevitable attrition of patients due to death resulted in an overall high risk of bias among the studies. No differences in survival or measures of dyspnea were observed in any of the studies. Total hospital length of stay was shorter, and repeat pleural interventions were less common in the IPC group (RR, 0.32; 95% CI, 0.18–0.55). However, the risk of cellulitis was higher with IPC (RR, 5.83; 95% CI, 1.56–21.8). No differences were noted in other adverse events. Conclusions: Compared with chemical pleurodesis, IPC results in shorter hospital length of stay and fewer repeat pleural procedures but carries a higher risk of cellulitis. Careful assessment of individual patient preferences and costs should be considered when choosing between IPC and pleurodesis.

Original languageEnglish (US)
Pages (from-to)124-131
Number of pages8
JournalAnnals of the American Thoracic Society
Volume16
Issue number1
DOIs
StatePublished - Jan 1 2019

Fingerprint

Pleurodesis
Malignant Pleural Effusion
Indwelling Catheters
Meta-Analysis
Length of Stay
Cellulitis
Odds Ratio
Confidence Intervals
Patient Preference
MEDLINE
Dyspnea
Thorax
Software
Catheters
Randomized Controlled Trials
Outcome Assessment (Health Care)
Guidelines
Costs and Cost Analysis
Survival

Keywords

  • Indwelling pleural catheter
  • Malignant pleural effusion
  • Meta-analysis
  • Pleurodesis
  • Systematic review

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Cite this

Indwelling pleural catheter versus pleurodesis for malignant pleural effusions a systematic review and meta-analysis. / Iyer, Narayan P.; Reddy, Chakravarthy B.; Wahidi, Momen M.; Lewis, Sandra Z.; Diekemper, Rebecca L.; Feller-Kopman, David; Gould, Michael K.; Balekian, Alex A.

In: Annals of the American Thoracic Society, Vol. 16, No. 1, 01.01.2019, p. 124-131.

Research output: Contribution to journalReview article

Iyer, Narayan P. ; Reddy, Chakravarthy B. ; Wahidi, Momen M. ; Lewis, Sandra Z. ; Diekemper, Rebecca L. ; Feller-Kopman, David ; Gould, Michael K. ; Balekian, Alex A. / Indwelling pleural catheter versus pleurodesis for malignant pleural effusions a systematic review and meta-analysis. In: Annals of the American Thoracic Society. 2019 ; Vol. 16, No. 1. pp. 124-131.
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abstract = "Rationale: Several randomized trials have compared the efficacy of an indwelling pleural catheter (IPC) versus the more traditional chemical pleurodesis in the management of malignant pleural effusion (MPE). Objectives: As part of the American Thoracic Society’s guidelines for management of MPE, we performed a systematic review and a meta-analysis to compare patient-centered outcomes with the use of a tunneled pleural catheter versus chemical pleurodesis for the first-line treatment of malignant pleural effusions. Methods: We performed literature searches in MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials. We included randomized controlled trials comparing IPC and pleurodesis in adult patients with symptomatic MPE. Risk of bias was assessed with the Cochrane Risk of Bias tool recommended by the Cochrane Methods Bias Group. The meta-analysis was performed with Review Manager software, using a random effects model. We used risk ratios (RRs) with 95{\%} confidence interval (CI) as the effect measure for dichotomous outcomes and mean differences for continuous outcomes. Results: We identified five randomized trials, involving 545 patients, that compared IPC and pleurodesis. Lack of blinding and the inevitable attrition of patients due to death resulted in an overall high risk of bias among the studies. No differences in survival or measures of dyspnea were observed in any of the studies. Total hospital length of stay was shorter, and repeat pleural interventions were less common in the IPC group (RR, 0.32; 95{\%} CI, 0.18–0.55). However, the risk of cellulitis was higher with IPC (RR, 5.83; 95{\%} CI, 1.56–21.8). No differences were noted in other adverse events. Conclusions: Compared with chemical pleurodesis, IPC results in shorter hospital length of stay and fewer repeat pleural procedures but carries a higher risk of cellulitis. Careful assessment of individual patient preferences and costs should be considered when choosing between IPC and pleurodesis.",
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AU - Reddy, Chakravarthy B.

AU - Wahidi, Momen M.

AU - Lewis, Sandra Z.

AU - Diekemper, Rebecca L.

AU - Feller-Kopman, David

AU - Gould, Michael K.

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N2 - Rationale: Several randomized trials have compared the efficacy of an indwelling pleural catheter (IPC) versus the more traditional chemical pleurodesis in the management of malignant pleural effusion (MPE). Objectives: As part of the American Thoracic Society’s guidelines for management of MPE, we performed a systematic review and a meta-analysis to compare patient-centered outcomes with the use of a tunneled pleural catheter versus chemical pleurodesis for the first-line treatment of malignant pleural effusions. Methods: We performed literature searches in MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials. We included randomized controlled trials comparing IPC and pleurodesis in adult patients with symptomatic MPE. Risk of bias was assessed with the Cochrane Risk of Bias tool recommended by the Cochrane Methods Bias Group. The meta-analysis was performed with Review Manager software, using a random effects model. We used risk ratios (RRs) with 95% confidence interval (CI) as the effect measure for dichotomous outcomes and mean differences for continuous outcomes. Results: We identified five randomized trials, involving 545 patients, that compared IPC and pleurodesis. Lack of blinding and the inevitable attrition of patients due to death resulted in an overall high risk of bias among the studies. No differences in survival or measures of dyspnea were observed in any of the studies. Total hospital length of stay was shorter, and repeat pleural interventions were less common in the IPC group (RR, 0.32; 95% CI, 0.18–0.55). However, the risk of cellulitis was higher with IPC (RR, 5.83; 95% CI, 1.56–21.8). No differences were noted in other adverse events. Conclusions: Compared with chemical pleurodesis, IPC results in shorter hospital length of stay and fewer repeat pleural procedures but carries a higher risk of cellulitis. Careful assessment of individual patient preferences and costs should be considered when choosing between IPC and pleurodesis.

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