Management of malignant pleural effusions using an indwelling tunnelled pleural catheter and non-vacuum collection system.

[BACKGROUND] Indwelling tunnelled pleural catheters (TPCs) are a minimally invasive way to palliate symptoms for patients with recurrent symptomatic malignant pleural effusions. Current data on TPCs have used vacuum-assisted drainage systems. Gravity-based drainage systems may represent an alternative approach with improvement in patient symptoms, but have a smaller overall footprint and a decreased cost. We therefore aimed to understand the efficacy, complication rate and spontaneous pleurodesis rate of a TPC that uses a non-vacuum-assisted drainage system.

[METHODS] This is a prospective, observational study of 40 patients who underwent placement of a TPC with a non-vacuum-assisted drainage system for management of recurrent symptomatic malignant pleural effusions. The primary outcome of interest was dyspnoea as assessed by a 100 mm Visual Analogue Scale for Dyspnoea (VAS-Dyspnoea) at 2 weeks following insertion. Secondary outcomes included catheter-related complications and spontaneous pleurodesis. Patients were seen in follow-up at 2 weeks post-catheter placement and then every 6 weeks.

[RESULTS] Among 40 patients who underwent TPC placement, the median age was 64 years, 65% were female, 80% were white and 20% were black. At baseline, participants had a median VAS-Dyspnoea score of 43 mm and at 2 weeks, participants (n=24) had a median VAS-Dyspnoea score of 16 mm (IQR: 6, 50) (p=0.07). A total of 19 (47.5%) patients experienced some form of TPC-related complication. A total of 15 (37.5%) achieved pleurodesis at a median of 55 days following catheter placement.

[CONCLUSIONS] In this single-centre, prospective cohort of patients with recurrent symptomatic malignant pleural effusions, TPCs with a non-vacuum-assisted drainage showed a trend towards improvement in dyspnoea with complications and pleurodesis similar to vacuum-based TPC systems.