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Respiration; International Review of... 2022Congenital chylothorax (CCT) of the newborn is a rare entity but the most common cause of pleural effusion in this age-group. We aimed to find the optimal treatment...
BACKGROUND
Congenital chylothorax (CCT) of the newborn is a rare entity but the most common cause of pleural effusion in this age-group. We aimed to find the optimal treatment strategy.
MATERIAL AND METHODS
A PubMed search was performed according to the PRISMA criteria. All cases were analyzed according to prenatal, perinatal, and postnatal treatment modalities and follow-ups.
RESULTS
We identified 753 cases from 157 studies published between 1990 and 2018. The all-cause mortality rate was 28%. Prematurity was present in 71%, male gender dominated 57%, mean gestational age was 34 weeks, and birth weight was 2,654 g. Seventy-nine percent of newborns had bilateral CCT, the most common associated congenital anomalies with CCT were pulmonary lymphangiectasia and pulmonary hypoplasia, and the most common chromosomal aberrations were Down, Noonan, and Turner syndromes, respectively. Mechanical ventilation was reported in 381 cases for mean 17 (range 1-120) days; pleural punctuations and drainages were performed in 32% and 64%, respectively. Forty-four percent received total parenteral nutrition (TPN) for mean 21 days, 46% medium-chain triglyceride (MCT) diet for mean 37 days, 20% octreotide, and 3% somatostatin; chemical pleurodesis was performed in 116 cases, and surgery was reported in 48 cases with a success rate of 69%. In 462 cases (68%), complete restitution was reported; in 34 of 44 cases (77%), intrauterine intervention was carried out.
CONCLUSION
Respiratory support, pleural drainages, TPN, and MCT diet as octreotide remain to be the cornerstones of CCT management. Pleurodesis with OK-432 done prenatally and povidone-iodine postnatally might be discussed for use in life-threatening CCT.
Topics: Chylothorax; Female; Humans; Infant; Infant, Newborn; Male; Octreotide; Pleural Effusion; Pleurodesis
PubMed: 34515211
DOI: 10.1159/000518217 -
Clinics in Chest Medicine Dec 2021Malignant pleural effusions have a significant burden on patients and the health care system. Diagnosis is typically via thoracentesis, although other times more... (Review)
Review
Malignant pleural effusions have a significant burden on patients and the health care system. Diagnosis is typically via thoracentesis, although other times more invasive procedures are required. Management centers around relief of dyspnea and patient quality of life and can be done via serial thoracentesis, indwelling pleural catheter, or pleurodesis. This article focuses on the diagnosis and management of malignant pleural effusion.
Topics: Catheters, Indwelling; Dyspnea; Humans; Pleural Effusion, Malignant; Pleurodesis; Quality of Life; Talc
PubMed: 34774175
DOI: 10.1016/j.ccm.2021.08.004 -
Chest Mar 2019
Topics: Humans; Pleural Effusion, Malignant; Pleurodesis; Ultrasonography
PubMed: 30846071
DOI: 10.1016/j.chest.2018.11.022 -
Seminars in Respiratory and Critical... Jun 2019Symptomatic pleural disease, specifically malignant pleural effusion, refractory benign pleural effusion, and pneumothoraces are common diseases that often require... (Review)
Review
Symptomatic pleural disease, specifically malignant pleural effusion, refractory benign pleural effusion, and pneumothoraces are common diseases that often require therapeutic interventions. The spectrum of management strategies often includes selection of a chemical pleurodesis agent administered in combination with an indwelling pleural catheter or chest tube.Additionally, there is a role for minimally invasive techniques which include medical thoracoscopy or more advanced video-assisted thoracoscopic approaches. Ongoing clinical trials continue to evolve best practices regarding the optimal sclerosant agents and procedural approaches in the management of these diseases.
Topics: Humans; Pleural Diseases; Pleural Effusion, Malignant; Pleurodesis; Pneumothorax; Povidone-Iodine; Sclerosing Solutions; Silver Nitrate; Talc; Tetracyclines; Thoracoscopy
PubMed: 31525812
DOI: 10.1055/s-0039-1693997 -
JAMA Jan 2020Malignant pleural effusion (MPE) is challenging to manage. Talc pleurodesis is a common and effective treatment. There are no reliable data, however, regarding the... (Comparative Study)
Comparative Study Randomized Controlled Trial
Effect of Thoracoscopic Talc Poudrage vs Talc Slurry via Chest Tube on Pleurodesis Failure Rate Among Patients With Malignant Pleural Effusions: A Randomized Clinical Trial.
IMPORTANCE
Malignant pleural effusion (MPE) is challenging to manage. Talc pleurodesis is a common and effective treatment. There are no reliable data, however, regarding the optimal method for talc delivery, leading to differences in practice and recommendations.
OBJECTIVE
To test the hypothesis that administration of talc poudrage during thoracoscopy with local anesthesia is more effective than talc slurry delivered via chest tube in successfully inducing pleurodesis.
DESIGN, SETTING, AND PARTICIPANTS
Open-label, randomized clinical trial conducted at 17 UK hospitals. A total of 330 participants were enrolled from August 2012 to April 2018 and followed up until October 2018. Patients were eligible if they were older than 18 years, had a confirmed diagnosis of MPE, and could undergo thoracoscopy with local anesthesia. Patients were excluded if they required a thoracoscopy for diagnostic purposes or had evidence of nonexpandable lung.
INTERVENTIONS
Patients randomized to the talc poudrage group (n = 166) received 4 g of talc poudrage during thoracoscopy while under moderate sedation, while patients randomized to the control group (n = 164) underwent bedside chest tube insertion with local anesthesia followed by administration of 4 g of sterile talc slurry.
MAIN OUTCOMES AND MEASURES
The primary outcome was pleurodesis failure up to 90 days after randomization. Secondary outcomes included pleurodesis failure at 30 and 180 days; time to pleurodesis failure; number of nights spent in the hospital over 90 days; patient-reported thoracic pain and dyspnea at 7, 30, 90, and 180 days; health-related quality of life at 30, 90, and 180 days; all-cause mortality; and percentage of opacification on chest radiograph at drain removal and at 30, 90, and 180 days.
RESULTS
Among 330 patients who were randomized (mean age, 68 years; 181 [55%] women), 320 (97%) were included in the primary outcome analysis. At 90 days, the pleurodesis failure rate was 36 of 161 patients (22%) in the talc poudrage group and 38 of 159 (24%) in the talc slurry group (adjusted odds ratio, 0.91 [95% CI, 0.54-1.55]; P = .74; difference, -1.8% [95% CI, -10.7% to 7.2%]). No statistically significant differences were noted in any of the 24 prespecified secondary outcomes.
CONCLUSIONS AND RELEVANCE
Among patients with malignant pleural effusion, thoracoscopic talc poudrage, compared with talc slurry delivered via chest tube, resulted in no significant difference in the rate of pleurodesis failure at 90 days. However, the study may have been underpowered to detect small but potentially important differences.
TRIAL REGISTRATION
ISRCTN Identifier: ISRCTN47845793.
Topics: Aged; Chest Tubes; Drainage; Female; Humans; Male; Middle Aged; Pleural Effusion, Malignant; Pleurodesis; Talc; Thoracoscopy; Treatment Failure
PubMed: 31804680
DOI: 10.1001/jama.2019.19997 -
Ugeskrift For Laeger Apr 2021Malignant pleural effusion (MPE) is a common condition, often associated with a high level of symptoms. In this review, several palliative treatments for symptomatic MPE... (Review)
Review
Malignant pleural effusion (MPE) is a common condition, often associated with a high level of symptoms. In this review, several palliative treatments for symptomatic MPE are summarised, including repeated thoracentesis, pleurodesis and insertion of indwelling pleural catheters. Choice of treatment depends on patient symptoms, life expectancy, pleural fluid production, expected effect of oncological treatment, whether trapped lung is suspected or not, and patient preferences. Treatment should be discussed with a pulmonary specialist with knowledge of pleural diseases.
Topics: Catheters, Indwelling; Drainage; Humans; Pleural Effusion, Malignant; Pleurodesis; Thoracentesis
PubMed: 33913425
DOI: No ID Found -
JAMA Nov 2017Indwelling pleural catheter and talc pleurodesis are established treatments for malignant pleural effusions among patients with poor prognosis. (Comparative Study)
Comparative Study Randomized Controlled Trial
IMPORTANCE
Indwelling pleural catheter and talc pleurodesis are established treatments for malignant pleural effusions among patients with poor prognosis.
OBJECTIVE
To determine whether indwelling pleural catheters are more effective than talc pleurodesis in reducing total hospitalization days in the remaining lifespan of patients with malignant pleural effusion.
DESIGN, SETTING, AND PARTICIPANTS
This open-label, randomized clinical trial included participants recruited from 9 centers in Australia, New Zealand, Singapore, and Hong Kong between July 2012 and October 2014; they were followed up for 12 months (study end date: October 16, 2015). Patients (n = 146) with symptomatic malignant pleural effusion who had not undergone indwelling pleural catheter or pleurodesis treatment were included.
INTERVENTIONS
Participants were randomized (1:1) to indwelling pleural catheter (n = 74) or talc pleurodesis (n = 72), minimized by malignancy (mesothelioma vs others) and trapped lung (vs not), and stratified by region (Australia vs Asia).
MAIN OUTCOMES AND MEASURES
The primary end point was the total number of days spent in hospital from procedure to death or to 12 months. Secondary outcomes included further pleural interventions, patient-reported breathlessness, quality-of-life measures, and adverse events.
RESULTS
Among the 146 patients who were randomized (median age, 70.5 years; 56.2% male), 2 withdrew before receiving the randomized intervention and were excluded. The indwelling pleural catheter group spent significantly fewer days in hospital than the pleurodesis group (median, 10.0 [interquartile range [IQR], 3-17] vs 12.0 [IQR, 7-21] days; P = .03; Hodges-Lehmann estimate of difference, 2.92 days; 95% CI, 0.43-5.84). The reduction was mainly in effusion-related hospitalization days (median, 1.0 [IQR, 1-3] day with the indwelling pleural catheter vs 4.0 (IQR, 3-6) days with pleurodesis; P < .001; Hodges-Lehmann estimate, 2.06 days; 95% CI, 1.53-2.58). Fewer patients randomized to indwelling pleural catheter required further ipsilateral invasive pleural drainages (4.1% vs 22.5%; difference, 18.4%; 95% CI, 7.7%-29.2%). There were no significant differences in improvements in breathlessness or quality of life offered by indwelling pleural catheter or talc pleurodesis. Adverse events were seen in 22 patients in the indwelling pleural catheter group (30 events) and 13 patients in the pleurodesis group (18 events).
CONCLUSIONS AND RELEVANCE
Among patients with malignant pleural effusion, treatment with an indwelling pleural catheter vs talc pleurodesis resulted in fewer hospitalization days from treatment to death, but the magnitude of the difference is of uncertain clinical importance. These findings may help inform patient choice of management for pleural effusion.
TRIAL REGISTRATION
anzctr.org.au Identifier: ACTRN12611000567921.
Topics: Adult; Aged; Aged, 80 and over; Breast Neoplasms; Catheterization; Catheters, Indwelling; Female; Humans; Length of Stay; Lung Neoplasms; Male; Mesothelioma; Mesothelioma, Malignant; Middle Aged; Pleural Effusion, Malignant; Pleurodesis; Quality of Life; Talc
PubMed: 29164255
DOI: 10.1001/jama.2017.17426 -
Clinics in Chest Medicine Dec 2021Recurrent, symptomatic pleural effusions are common and can contribute to significant morbidity in affected patients. Various management options are available and... (Review)
Review
Recurrent, symptomatic pleural effusions are common and can contribute to significant morbidity in affected patients. Various management options are available and indwelling pleural catheter placement is becoming more commonplace and is the preferred option in certain clinical scenarios. The body of literature pertaining to indwelling pleural catheter use has grown substantially over the last decade and the purpose of this review is to summarize the best available evidence.
Topics: Catheters, Indwelling; Drainage; Humans; Pleural Effusion; Pleural Effusion, Malignant; Pleurodesis
PubMed: 34774179
DOI: 10.1016/j.ccm.2021.08.009 -
Current Opinion in Pulmonary Medicine Jul 2020Malignant pleural effusion (MPE) is a common cause of breathlessness indicative of advanced disease. Treatment approaches focus on relief of breathlessness and... (Review)
Review
PURPOSE OF REVIEW
Malignant pleural effusion (MPE) is a common cause of breathlessness indicative of advanced disease. Treatment approaches focus on relief of breathlessness and optimizing quality of life. A number of recent, high-impact publications give further insight into the advantages of different treatment options. This article provides a summary of the most up-to-date evidence in this area.
RECENT FINDINGS
Recent publications have demonstrated comparable pleurodesis outcomes of talc slurry to talc poudrage and explore strategies to combine the advantages of indwelling pleural catheters (IPCs) with a chemical pleurodesis. A daily IPC drainage regime improves the chances of pleurodesis success and early IPC removal in patients without significant trapped lung.
SUMMARY
MPE is a diverse condition, with no one strategy representing the 'best' approach for all. Management decisions should be made in conjunction with the patient, taking their views and preferences into consideration.
Topics: Disease Management; Drainage; Humans; Pleural Effusion, Malignant; Pleurodesis; Quality of Life; Talc
PubMed: 32487872
DOI: 10.1097/MCP.0000000000000685 -
Respirology (Carlton, Vic.) Jul 2020
Topics: Biomarkers; Humans; Lung; Pleural Effusion, Malignant; Pleurodesis; Talc
PubMed: 31945800
DOI: 10.1111/resp.13765