Abstract
BACKGROUND: There are guidelines recommending the use of Indwelling pleural catheter (IPC), but there is no established consensus or guidelines regarding the modality of drainage post-IPC insertion. We have devised a novel drainage technique that combines the advantages of both aggressive and symptom-guided drainage. METHOD: This was a prospective intervention trial in which patients with malignant pleural effusion, drained with IPC, were initially given one week of 'high-intensity' drainage on an outpatient basis using a low-pressure suction pump, followed by symptom-based home drainage using vacuum bottles. Patients were assessed for improvement in breathlessness, the number of autos pleurodesis, and the number of vacuum bottles consumed. RESULTS: A total of 25 patients with malignant pleural effusion who satisfied the inclusion criteria were selected. The mean breathlessness as per the visual analogue scale (VAS) was 87 before the insertion of IPC, which decreased to 48.2 immediately after IPC insertion and drainage. The 'high-intensity' drainage was able to maintain this fall in VAS. Thirteen patients (52%) achieved pleurodesis, of which 10 achieved pleurodesis after 5 weeks of IPC insertion, and 3 achieved pleurodesis after 7 weeks of IPC insertion. Eleven patients (44%) had the IPC in situ until death. One patient had the IPC removed due to empyema. None of the 10 patients who achieved pleurodesis within 5 weeks of IPC insertion had to use vacuum bottles at home for 'symptom-guided' fluid drainage. CONCLUSION: This novel method of draining malignant pleural effusion brought about symptomatic improvement, increase auto-pleurodesis, and thereby reduce the number of vacuum bottles consumed in the study population.