What is the key question?

• Does the use of indwelling pleural catheters (IPC) improve dyspnea in patients with refractory symptomatic transudative pleural effusions?

What is the bottom line?

• This study is a multicenter, randomized, controlled trial in which patients with transudative pleural effusions were randomly assigned to either an IPC (intervention, n=33) or therapeutic thoracentesis (TT; standard care, n=35). The primary outcome was the mean daily breathlessness score over 12 weeks from randomization using a visual analog scale (VAS). The underlying etiology of the effusion was heart failure-related (n=46), liver failure-related (n=16) and renal failure-related (n=6).
• The study found that the mean breathlessness VAS score over the 12-week study period was 39.7 mm in the IPC group and 45.0 mm in the TT group (p=0.67). The mean drainage volume was 17,412 mL and 2901 mL in the IPC and TT groups, respectively. A greater proportion of patients had at least one adverse event in the IPC group (p=0.04).

Why read on?

• This study found that pleural fluid drainage via an IPC did not confer an additional advantage over repeated thoracentesis drainage with regards to dyspnea relief for patients with refractory symptomatic transudative pleural effusions. There were more complications associated with the IPC approach.