Comparative study between indwelling pleural drain and intercostal drainage followed by pleurodesis in management of malignant pleural effusion
Keywords:Indwelling catheter, Intercostal drainage, Malignant pleural effusion, Indwelling pleural drain
Background: Malignant pleural effusion is a major cause of morbidity in lung cancer patients. Management involves repeated pleural aspirations or persistent intercostal drainage (ICD) tube. Using an indigenous method of putting ICD tube of smaller size with subcutaneous tunnelling allows draining fluid from lungs easily and painlessly when needed avoiding the need for repeated injections and chest tube insertion.
Methods: In this prospective, 48 months study, 100 patients of malignant pleural effusion were included in the study and half of them were treated with intercostals drainage followed by pleurodesis and the remaining half were treated with a indwelling pleural catheter (IPC). The end points taken were hospital bed days, complications, cost and quality of life insertion.
Results: In the IPC group the average baseline dyspnoea score (visual analogue scale) of the patients was 61.23±22.10 and at 6 months it was 5.65 (p <0.05). In ICD group average baseline dyspnoea score was 64.44±27.40 and at 6 months it was 14.09 (p <0.05). In IPC group the average baseline quality of life score was found to be 41.18±9.40 and at 6 months it was 69.87 (p <0.05). In ICD group average baseline quality of life score was found to be 43.21±7.84 at 6 months it was 58.88 (p <0.05). In terms of hospital readmission around 8 patients (16%) belonging to IPC group needed it and in ICD group 17 patients (34%) needed it. The commonest complication found in IPC group was catheter blockage and it was seen in 13 patients (26%). In ICD group the commonest complication was the need for repeat drainage seen in 12 patients (24%).
Conclusions: Indwelling pleural catheter is a low cost, easily available and successful alternative option to intercostals drainage in patients having persistent malignant pleural effusion and it provides a better quality of life to patients.
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