Minimally Invasive Management of Chronic Pleural Empyema with Tunneled Pleural Catheters

Overview

Tunneled pleural catheters (TPCs) offer a feasible, minimally invasive option for managing chronic pleural empyema in patients with non-expandable lungs who are poor surgical candidates. Systematic review data indicate high rates of infection control and symptom relief, with acceptable safety profiles and potential for pleurodesis.

Background

Chronic pleural empyema in non-expandable lungs poses significant treatment challenges, especially in frail or high-risk patients unsuitable for surgery. Traditional surgical interventions include decortication and open window thoracostomy, but these may not be viable for all patients. Minimally invasive approaches, such as TPC placement, have gained interest as alternatives. However, clinical evidence regarding their efficacy and safety in chronic pleural infections remains limited and primarily observational.

Data Highlights

Key Findings

• Tunneled pleural catheters achieved complete or partial infection resolution in the majority of cases, with some cohorts reporting up to 100% success.
• The overall infection rate related to TPC use was low at 4.9%, with a very low infection-related mortality of 0.29%.
• More than 60% of patients experienced pleurodesis following infection control, indicating effective pleural symphysis formation.
• Symptom relief and radiological improvement were consistently reported across case reports and small series over weeks to months of follow-up.
• Intrapleural fibrinolytic therapy was safely administered via TPCs in selected cases, expanding therapeutic options.
• TPCs facilitate ambulatory care and may reduce hospitalization duration in high-risk patients unfit for surgery.

Clinical Implications

TPCs represent a viable minimally invasive alternative for managing chronic pleural empyema in patients with non-expandable lungs who cannot undergo surgery. Their use can improve infection control, promote pleurodesis, and provide symptom relief while enabling outpatient management. Clinicians should consider TPCs within a multidisciplinary, individualized treatment plan, recognizing the need for further prospective studies to optimize patient selection and protocols.

Conclusion

Tunneled pleural catheters offer a promising surgical alternative for chronic pleural empyema in non-expandable lungs among non-surgical candidates, demonstrating efficacy and safety in infection control and symptom management. Further research is warranted to establish standardized guidelines and long-term outcomes.

References

1. Krumm IR, Gesthalter YB (2022) -- Use of tunneled pleural catheters in chronic empyema: two case reports and brief review of the literature
2. Feller-Kopman D et al (2018) -- Management of malignant pleural effusions: an official ATS/STS/STR clinical practice guideline
3. Roberts ME et al (2023) -- British Thoracic Society guideline for pleural disease
4. Majid A et al (2019) -- Tunneled pleural catheters for patients with chronic pleural infection and nonexpandable lung