Invited Commentary

Abstract

Tunneled pleural catheters were initially introduced as an alternative to pleurodesis for patients with malignant pleural effusions. These catheters offered another treatment option for patients with poor pulmonary reserve who might not tolerate pleurodesis or for patients whose tumor burden might prevent pleural symphysis, resulting in low success rates for pleurodesis. Additionally, the pleural catheters could be placed as an outpatient procedure and thus were shown to have cost advantages compared with surgical sclerosis. The article by Dr Krishnan and colleagues [1Krishnan M. Cheriyath P. Wert Y. Moritz T.A. The untapped potential of tunneled pleural catheters.Ann Thorac Surg. 2015; 100: 2055-2058Google Scholar] discusses the potential benefits of using these tunneled pleural catheters to treat nonmalignant effusions. The study reported on 37 patients with a variety of medical problems, including heart failure, liver disease, and chronic renal failure, who were treated for their chronic effusions. They had excellent results with 31 of the patients (83%), achieving successful pleurodesis in, on average, 56 days. Additionally, hospital admissions decreased for these patients from 60 to 9 days in the first year, and no major adverse events were reported. Chronic recalcitrant nonmalignant effusions represent a therapeutic dilemma for treating physicians. Chemical pleurodesis and pleurectomy have been shown to have marginal success rates for these types of effusions, and repeated thoracentesis is an inefficient and burdensome process for patients and doctors. As with any disease, the causes of nonmedical effusions must be explored to be sure that there is not an effective treatment outside of chronic drainage. This may even include thoracoscopy to rule out trapped lung or inflammatory pleural processes that could be treated with decortication or antiinflammatory medicines, respectively. I have used tunneled pleural catheters in my own practice to treat chronic nonmalignant pleural effusions. In general I have had good results. However, I have had 2 patients experience empyema, requiring catheter removal, and 1 patient had a nonfunctional catheter, requiring replacement. Physicians using this treatment must follow up their patients closely to make sure that adverse events are diagnosed and treated in a timely fashion. In summary, the article by Dr Krishnan and colleague provides excellent data to support the use of tunneled pleural catheters to treat patients with recurrent nonmalignant effusions. This approach offers a much-needed treatment option for patients with a difficult and often frustrating problem. The Untapped Potential of Tunneled Pleural CathetersThe Annals of Thoracic SurgeryVol. 100Issue 6PreviewTunneled pleural catheters (TPCs) are routinely used for outpatient drainage of malignant pleural effusions, although use in recurrent pleural effusions resulting from nonmalignant conditions requires further evaluation. We hypothesized that TPCs could decrease inpatient admission rates for exacerbations of nonmalignant pleural effusions. Full-Text PDF