Clinical Scorecard: Minimally Invasive Approaches for Managing Chronic Pleural Empyema in Non-Expandable Lungs: A Systematic Review of the Efficacy of Tunneled Pleural Catheters as a Surgical Option

At a Glance

Key Highlights

• TPCs achieved infection control with complete or partial resolution rates up to 100% in selected cohorts.
• Infection rate associated with TPCs was low (4.9%) with infection-related mortality of 0.29%.
• TPCs may reduce hospitalization and support pleurodesis in patients unfit for surgery.

Guideline-Based Recommendations

Diagnosis

• Confirm chronic pleural empyema and assess lung expandability to identify non-expandable lung.

Management

• Consider tunneled pleural catheters as a minimally invasive alternative for patients unfit for surgery.
• Use intrapleural fibrinolytics safely via TPCs in selected cases to enhance drainage.
• Incorporate TPCs into individualized, multidisciplinary treatment plans.

Monitoring & Follow-up

• Monitor for infection signs related to TPCs and manage complications promptly.
• Assess symptom relief and radiological improvement during follow-up.
• Evaluate pleurodesis outcomes post-infection control.

Risks

• Potential for catheter-related infections, though rates are low.
• Risk of incomplete infection resolution requiring further intervention.

Patient & Prescribing Data

1,141 patients with chronic pleural infection and non-expandable lung, predominantly poor surgical candidates

TPCs provide effective infection control and symptom relief with low complication rates, facilitating outpatient management and pleurodesis in a majority of cases.

Clinical Best Practices

• Select patients carefully for TPC use based on surgical candidacy and lung expandability.
• Employ a multidisciplinary approach including pulmonologists, thoracic surgeons, and infectious disease specialists.
• Use TPCs to enable ambulatory care and reduce hospital stay duration.
• Consider adjunctive intrapleural fibrinolytics to improve drainage when appropriate.
• Conduct regular follow-up with clinical and radiological assessments to monitor treatment efficacy and complications.

References

• Krumm IR, Gesthalter YB (2022) Use of tunneled pleural catheters in chronic empyema
• Feller-Kopman D et al (2018) Management of malignant pleural effusions: ATS/STS/STR guideline
• Roberts ME et al (2023) British Thoracic Society guideline for pleural disease
• Majid A et al (2019) Tunneled pleural catheters for chronic pleural infection and nonexpandable lung
• Tremblay A, Michaud G (2006) Single-center experience with tunneled pleural catheter insertions
• Davies HE et al (2012) TIME2 randomized controlled trial on indwelling pleural catheter