An expert panel has released consensus statements, using the Delphi method, on the use of indwelling tunneled pleural catheters (IPCs) for recurrent pleural effusions. The statements were published in CHEST.
Although guidelines regarding patient selection and indications for IPC placement have been proposed, there is little guidance available on optimal IPC management once they are in situ. Therefore, an expert panel convened during a working session of the Interventional Pulmonology Working Group at the 2018 American Thoracic Society International Conference to create consensus statements.
Panel members included 25 physicians from different countries and specialties (interventional pulmonology, pulmonology, thoracic surgery, and infectious disease) who reviewed existing evidence about IPC complication management, catheter removal, and patient teaching. The members used a modified Delphi process to reach consensus, defined as a priori >80% agreement, on both perioperative and long-term management options of IPC use.
Surveys were also administered to participants to reach consensus. The first survey contained 33 open-ended questions, the second survey contained 65 multiple-choice questions, and the third survey contained 34 multiple-choice questions. In total, the panel reached consensus on 36 statements on IPC management.
Based on survey responses, the panel agreed that patients with localized IPC site infections should be treated as outpatients, unless the patient becomes clinically unstable and requires hospitalization. Additionally, the panel reached a consensus that patients with localized IPC site infections should be treated with antibiotics directed at typical gram-positive organisms for 7 to 10 days.
The panel also reached consensus on statements for deep space IPC pleural infections, stating that the IPC should remain in place during initial management and should be drained frequently. Drainage should be performed continuously for an inpatient and ≥1 per day for an outpatient. Additionally, the panel stated that surgery/decortication is not the optimal approach as first-line therapy in patients with deep space IPC pleural infections.
Also, the panel agreed on the use of full-body sterile draping during IPC placement in an effort to prevent IPC-related infections. They also reached consensus that IPC placement should be performed in a dedicated and sterile environment.
A limitation of the Delphi method used to reach these consensus statements included the inability of the method to identify why panel members chose certain survey answers.
In their statement, the investigators also indicated that additional “studies are now warranted in various aspects of [malignant pleural effusion] management, including the numerous questions and complications that can arise after IPC insertion,”
Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.
Gilbert CR, Wahidi MM, Light RW, et al. Management of indwelling tunneled pleural catheters: a modified Delphi consensus statement [published online June 16, 2020]. CHEST. doi:10.1016/j.chest.2020.05.594