Patil M1, Dhillon SS2, Attwood K3, Saoud M4, Alraiyes AH2, Harris K5.
Chest. 2017; 151: 626-635
[PubMed] [Texto completo]
Abstract
BACKGROUND:
The indwelling pleural catheter (IPC), which was initially introduced for the management of recurrent malignant effusions, could be a valuable management option for recurrent benign pleural effusion (BPE), replacing chemical pleurodesis. The purpose of this study is to analyze the efficacy and safety of IPC use in the management of refractory nonmalignant effusions.
METHODS:
We conducted a systematic review and meta-analysis on the published literature. Retrospective cohort studies, case series, and reports that used IPCs for the management of pleural effusion were included in the study.
RESULTS:
Thirteen studies were included in the analysis, with a total of 325 patients. Congestive heart failure (49.8%) was the most common cause of BPE requiring IPC placement. The estimated average rate of spontaneous pleurodesis was 51.3% (95% CI, 37.1%-65.6%). The estimated average rate of all complications was 17.2% (95% CI, 9.8%-24.5%) for the entire group. The estimated average rate of major complications included the following: empyema, 2.3% (95% CI, 0.0%-4.7%); loculation, 2.0% (95% CI, 0.0%-4.7%); dislodgement, 1.3% (95% CI, 0.0%-3.7%); leakage, 1.3% (95% CI, 0.0%-3.5%); and pneumothorax, 1.2% (95% CI, 0.0%-4.1%). The estimated average rate of minor complications included the following: skin infection, 2.7% (95% CI, 0.6%-4.9%); blockage and drainage failure, 1.1% (95% CI, 0.0%-3.5%); subcutaneous emphysema, 1.1% (95% CI, 0.0%-4.0%); and other, 2.5% (95% CI, 0.0%-5.2%). One death was directly related to IPC use.
CONCLUSIONS:
IPCs are an effective and viable option in the management of patients with refractory BPE. The quality of evidence to support IPC use for BPE remains low, and high-quality studies such as randomized controlled trials are needed
COMENTARIOS (Revisor Dr. Carlos Vilariño)
El catéter pleural tunelizado se ha convertido en una opción terapéutica para el derrame pleural maligno. Su inserción resulta sencilla, supone escasos riesgos y consigue buenos resultados a corto-medio plazo. Se han comunicado algunas experiencias con estos catéteres en derrames pleurales benignos (insuficiencia cardíaca, hidrotórax hepático, insuficiencia renal,…), pero las evidencias en este terreno son escasas.
En el actual trabajo se evalúan la eficacia y seguridad de esta modalidad terapéutica en el manejo del derrame pleural no maligno recurrente y de difícil control. Lo autores realizan una revisión sistemática y un metaanálisis de 13 estudios de cohortes retrospectivas, series de casos, …. Incluyendo 325 pacientes, la mayoría con insuficiencia cardíaca. Se consiguió pleurodesis en el 51% de los casos (una proporción similar a la conseguida en los derrames malignos), con un índice de complicaciones del 17%, la mayoría no importantes.
Aunque el trabajo cuenta con la importante limitación de incluir únicamente estudios retrospectivos, proporciona cierto respaldo a la hora de utilizar este tratamiento en pacientes con derrame pleural benigno de difícil control a pesar de los tratamientos habituales. Se remarca que se trata de una terapia paliativa.