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Najib M Rahman - One of the best experts on this subject based on the ideXlab platform.

  • transposition of the great indwelling Pleural Catheter
    Thorax, 2021
    Co-Authors: Eihab O Bedawi, Najib M Rahman, Radhika Banka, Fergus V Gleeson, John M Wrightson
    Abstract:

    A 70-year-old male with sarcomatoid renal carcinoma presented to his general practitioner with worsening breathlessness. He was referred to the radiology department for a radiograph of the chest, which showed recurrence of a known right malignant Pleural effusion (MPE) (figure 1A). After 4 days, he underwent an uncomplicated right indwelling Pleural Catheter (IPC) insertion and drainage. The postprocedure radiograph of the chest (figure 1B) showed improved appearances of the right MPE and a new small left Pleural effusion that had been seen on the preprocedure ultrasound and likely progressed since his presenting radiograph. The radiographer’s report raised concerns that the right IPC tip …

  • malignant Pleural effusion management keeping the flood gates shut
    The Lancet Respiratory Medicine, 2020
    Co-Authors: Steven Walker, Nick A Maskell, Rachel Mercer, Najib M Rahman
    Abstract:

    With no cure for malignant Pleural effusion, efforts are focused on symptomatic management. Historically, this symptomatic management was achieved with the instillation of a sclerosant agent into the Pleural space to achieve pleurodesis. The development of the tunnelled indwelling Pleural Catheter and ambulatory Pleural drainage changed the management of malignant Pleural effusion, not solely by offering an alternative management pathway, but by challenging how health-care providers view success in a palliative condition. Furthermore, with additional treatment options available, increased imperative exists to better characterise patients to enable a personalised approach to their care. We have done a review of the scientific literature and clinical trial registries to provide an overview of the current and ground-breaking research published in the past 10 years.

  • novel mouse model of indwelling Pleural Catheter in mice with malignant Pleural effusion
    ERJ Open Research, 2019
    Co-Authors: Christopher M Merrick, Najib M Rahman, Georgios T Stathopoulos, Taylor P Sherrill, Nikolaos I Kanellakis, Rachelle Asciak, Fabien Maldonado, Timothy S Blackwell, Ioannis Psallidas
    Abstract:

    This novel mouse model mimics malignant Pleural effusion drainage using an indwelling Pleural Catheter in humans, and provides direct access to the Pleural space potentially enabling the testing of intraPleural therapies in the treatment of MPE. bit.ly/2W2kzO0.

  • does attempting talc pleurodesis affect subsequent indwelling Pleural Catheter ipc related non draining septated Pleural effusion and ipc related spontaneous pleurodesis
    ERJ Open Research, 2019
    Co-Authors: Rachelle Asciak, Rachel Mercer, Nikolaos I Kanellakis, Ioannis Psallidas, Eihab O Bedawi, Robert J Hallifax, Maged Hassan, David J Mccracken, John Wrightson, Najib M Rahman
    Abstract:

    Prior talc pleurodesis does not result in worsened outcomes from subsequent indwelling Pleural Catheter use, and patients should not be dissuaded from choosing talc as a primary treatment for recurrent Pleural effusion. http://ow.ly/qAAC30mYmr3.

  • mesotrap a feasibility study that includes a pilot clinical trial comparing video assisted thoracoscopic partial pleurectomy decortication with indwelling Pleural Catheter in patients with trapped lung due to malignant Pleural mesothelioma designed t
    BMJ Open Respiratory Research, 2019
    Co-Authors: Claire Matthews, Carol J Freeman, Linda D Sharples, Julia Foxrushby, Nick A Maskell, John G Edwards, Aman S Coonar, Pasupathy Sivasothy, V F Hughes, Najib M Rahman
    Abstract:

    Introduction One of the most debilitating symptoms of malignant Pleural mesothelioma (MPM) is dyspnoea caused by Pleural effusion. MPM can be complicated by the presence of tumour on the visceral pleura preventing the lung from re-expanding, known as trapped lung (TL). There is currently no consensus on the best way to manage TL. One approach is insertion of an indwelling Pleural Catheter (IPC) under local anaesthesia. Another is video-assisted thoracoscopic partial pleurectomy/decortication (VAT-PD). Performed under general anaesthesia, VAT-PD permits surgical removal of the rind of tumour from the visceral pleura thereby allowing the lung to fully re-expand. Methods and analysis MesoTRAP is a feasibility study that includes a pilot multicentre, randomised controlled clinical trial comparing VAT-PD with IPC in patients with TL and Pleural effusion due to MPM. The primary objective is to measure the SD of visual analogue scale scores for dyspnoea following randomisation and examine the patterns of change over time in each treatment group. Secondary objectives include documenting survival and adverse events, estimating the incidence and prevalence of TL in patients with MPM, examining completion of alternative forms of data capture for economic evaluation and determining the ability to randomise 38 patients in 18 months. Ethics and dissemination This study was approved by the East of England-Cambridge Central Research Ethics Committee and the Health Research Authority (reference number 16/EE/0370). We aim to publish the outputs of this work in international peer-reviewed journals compliant with an Open Access policy. Trial registration NCT03412357.

Edward T H Fysh - One of the best experts on this subject based on the ideXlab platform.

  • effect of an indwelling Pleural Catheter vs talc pleurodesis on hospitalization days in patients with malignant Pleural effusion the ample randomized clinical trial
    JAMA, 2017
    Co-Authors: Rajesh Thomas, Edward T H Fysh, Nicola A Smith, Pyng Lee, Benjamin C H Kwan, Elaine Yap, Fiona C Horwood, Francesco Piccolo
    Abstract:

    Importance Indwelling Pleural Catheter and talc pleurodesis are established treatments for malignant Pleural effusions among patients with poor prognosis. Objective To determine whether indwelling Pleural Catheters are more effective than talc pleurodesis in reducing total hospitalization days in the remaining lifespan of patients with malignant Pleural effusion. Design, Setting, and Participants This open-label, randomized clinical trial included participants recruited from 9 centers in Australia, New Zealand, Singapore, and Hong Kong between July 2012 and October 2014; they were followed up for 12 months (study end date: October 16, 2015). Patients (n = 146) with symptomatic malignant Pleural effusion who had not undergone indwelling Pleural Catheter or pleurodesis treatment were included. Interventions Participants were randomized (1:1) to indwelling Pleural Catheter (n = 74) or talc pleurodesis (n = 72), minimized by malignancy (mesothelioma vs others) and trapped lung (vs not), and stratified by region (Australia vs Asia). Main Outcomes and Measures The primary end point was the total number of days spent in hospital from procedure to death or to 12 months. Secondary outcomes included further Pleural interventions, patient-reported breathlessness, quality-of-life measures, and adverse events. Results Among the 146 patients who were randomized (median age, 70.5 years; 56.2% male), 2 withdrew before receiving the randomized intervention and were excluded. The indwelling Pleural Catheter group spent significantly fewer days in hospital than the pleurodesis group (median, 10.0 [interquartile range [IQR], 3-17] vs 12.0 [IQR, 7-21] days; P  = .03; Hodges-Lehmann estimate of difference, 2.92 days; 95% CI, 0.43-5.84). The reduction was mainly in effusion-related hospitalization days (median, 1.0 [IQR, 1-3] day with the indwelling Pleural Catheter vs 4.0 (IQR, 3-6) days with pleurodesis; P Conclusions and Relevance Among patients with malignant Pleural effusion, treatment with an indwelling Pleural Catheter vs talc pleurodesis resulted in fewer hospitalization days from treatment to death, but the magnitude of the difference is of uncertain clinical importance. These findings may help inform patient choice of management for Pleural effusion. Trial Registration anzctr.org.au Identifier:ACTRN12611000567921

  • predictors of clinical use of pleurodesis and or indwelling Pleural Catheter therapy for malignant Pleural effusion
    Chest, 2015
    Co-Authors: Nick A Maskell, Edward T H Fysh, Silvia Bielsa, Charley A Budgeon, Catherine A Read, Jose M Porcel, Y Gary C Lee
    Abstract:

    BACKGROUND The clinical course of patients with malignant Pleural effusions (MPEs) varies. The decision to undertake “definitive therapy” (pleurodesis, indwelling Pleural Catheter [IPC], or both) for MPEs is decided on a case-by-case basis. Identifying factors that predict definitive therapy may help guide early initiation of treatment. The aim of the study was to identify clinical, laboratory, and radiologic predictors associated with clinicians' prescription of definitive therapy for patients with MPE. METHODS A multicenter, observational study was conducted over 55 months involving tertiary centers in Perth, Western Australia, Australia, and Lleida, Spain. Demographic, clinical, radiologic, biochemical, and histologic data and the treatments received were recorded. Logistic regression was performed to determine the variables useful for predicting definitive therapy. RESULTS Data of 540 patients (365 from Perth and 184 from Lleida) were analyzed; 537 fulfilled the criteria of an MPE. Definitive therapy was used in 288 patients (53.6'): 199 received a pleurodesis and 89 an IPC. Univariate analysis of the combined cohort revealed that definitive therapy was more likely if the effusion has low pH, either as a continuous variable (OR, 30.30; P P = .03); was large (> 50' of hemithorax) (OR, 2.75; P P P P P = .01) were associated with the use of definitive therapy. CONCLUSIONS Patients with MPE with an effusion of low Pleural fluid pH and large size on radiographs at first presentation are more likely to be treated with pleurodesis and/or IPC.

  • protocol of the australasian malignant Pleural effusion ample trial a multicentre randomised study comparing indwelling Pleural Catheter versus talc pleurodesis
    BMJ Open, 2014
    Co-Authors: Rajesh Thomas, Edward T H Fysh, Elaine Yap, Fiona C Horwood, Catherine A Read, Ben C H Lam, Pyng Lee
    Abstract:

    Introduction Malignant Pleural effusion can complicate most cancers. It causes breathlessness and requires hospitalisation for invasive Pleural drainages. Malignant effusions often herald advanced cancers and limited prognosis. Minimising time spent in hospital is of high priority to patients and their families. Various treatment strategies exist for the management of malignant effusions, though there is no consensus governing the best choice. Talc pleurodesis is the conventional management but requires hospitalisation (and substantial healthcare resources), can cause significant side effects, and has a suboptimal success rate. Indwelling Pleural Catheters (IPCs) allow ambulatory fluid drainage without hospitalisation, and are increasingly employed for management of malignant effusions. Previous studies have only investigated the length of hospital care immediately related to IPC insertion. Whether IPC management reduces time spent in hospital in the patients’ remaining lifespan is unknown. A strategy of malignant effusion management that reduces hospital admission days will allow patients to spend more time outside hospital, reduce costs and save healthcare resources. Methods and analysis The Australasian Malignant Pleural Effusion (AMPLE) trial is a multicentred, randomised trial designed to compare IPC with talc pleurodesis for the management of malignant Pleural effusion. This study will randomise 146 adults with malignant Pleural effusions (1:1) to IPC management or talc slurry pleurodesis. The primary end point is the total number of days spent in hospital (for any admissions) from treatment procedure to death or end of study follow-up. Secondary end points include hospital days specific to Pleural effusion management, adverse events, self-reported symptom and quality-of-life scores. Ethics and dissemination The Sir Charles Gairdner Group Human Research Ethics Committee has approved the study as have the ethics boards of all the participating hospitals. The trial results will be published in peer-reviewed journals and presented at scientific conferences. Trial registration numbers Australia New Zealand Clinical Trials Registry—ACTRN12611000567921; National Institutes of Health—NCT02045121.

  • clinical outcomes of indwelling Pleural Catheter related Pleural infections an international multicenter study
    Chest, 2013
    Co-Authors: David Fellerkopman, Edward T H Fysh, Alain Tremblay, Eleanor K Mishra, Mark Slade, Luke A Garske, Amelia O Clive, Carla Lamb, Rogier C Boshuizen
    Abstract:

    Background Indwelling Pleural Catheters (IPCs) offer effective control of malignant Pleural effusions (MPEs). IPC-related infection is uncommon but remains a major concern. Individual IPC centers see few infections, and previous reports lack sufficient numbers and detail. This study combined the experience of 11 centers from North America, Europe, and Australia to describe the incidence, microbiology, management, and clinical outcomes of IPC-related Pleural infection. Methods This was a multicenter retrospective review of 1,021 patients with IPCs. All had confirmed MPE. Results Only 50 patients (4.9%) developed an IPC-related Pleural infection; most (94%) were successfully controlled with antibiotics (62% IV). One death (2%) directly resulted from the infection, whereas two patients (4%) had ongoing infectious symptoms when they died of cancer progression. Staphylococcus aureus was the causative organism in 48% of cases. Infections from gram-negative organisms were associated with an increased need for continuous antibiotics or death (60% vs 15% in gram-positive and 25% mixed infections, P = .02). The infections in the majority (54%) of cases were managed successfully without removing the IPC. Postinfection pleurodesis developed in 31 patients (62%), especially those infected with staphylococci (79% vs 45% with nonstaphylococcal infections, P = .04). Conclusions The incidence of IPC-related Pleural infection was low. The overall mortality risk from Pleural infection in patients treated with IPC was only 0.29%. Antibiotics should cover S aureus and gram-negative organisms until microbiology is confirmed. Postinfection pleurodesis is common and often allows removal of IPC. Heterogeneity in management is common, and future studies to define the optimal treatment strategies are needed.

  • indwelling Pleural Catheter changing the paradigm of malignant effusion management
    Journal of Thoracic Oncology, 2011
    Co-Authors: Y Gary C Lee, Edward T H Fysh
    Abstract:

    Malignant Pleural effusions (MPEs) affect as many as 150,000 patients with cancer in the United States1 and 100,000 patients with lung cancer2 in Europe each year. Inpatient care alone for MPE costs US$6 million per million population in Australia annually (data, the Western Australia Health Dept). The exciting advent of indwelling tunneled Pleural Catheters (IPCs) has critically challenged conventional approaches to MPE management, especially pleurodesis.3 IPCs offer ambulatory fluid drainage as the primary symptomatic therapy, thus prompting clinicians to redefine the goalposts of MPE care. Talc pleurodesis has been the mainstay of MPE management for decades, but its efficacy and safety have recently come under scrutiny.4 In the largest randomized trial in Pleural disease (n 486),5 talc (poudrage or slurry) pleurodesis had a suboptimal success rate: only 75% of MPE patients at 1 month and 50% by 6 months had adequate fluid control. Adding the fact that many patients are unsuitable for pleurodesis (e.g., with trapped lungs), talc pleurodesis benefits only a subset of all MPE patients. Randomized trials have also shown that talc induces lung and systemic inflammation6 and killed 2.3% of patients in a Cancer and Leukemia Group B study through talc-induced respiratory failure.5 Although this acute lung injury can be avoided by using large particle size talc preparations,7 such products are not readily available in many countries, including the United States. These data have provoked debates and compelled the Pleural community to revisit the principles of MPE care. The fundamental aim in MPE management is to improve dyspnea and quality of life, with minimal intervention and hospitalization. The timely introduction of IPCs which allow fluid evacuation from a single minimally invasive procedure serves exactly this purpose and explains its rapid rise in popularity (Suzuki et al estimated that 39,000 units sold in the United States per year8). Suzuki et al.8 in this issue of Journal of Thoracic Oncology reported the largest series of IPC (n 418) experience, providing corroborative evidence that IPCs are safe.9–12 A recent summary of all published reports on IPC complications revealed that most complaints were minor (e.g., mild pain after insertion).13 A systematic review including 1370 patients has confirmed that serious complications, e.g., infection were uncommon ( 3%).14 Other series have addressed specific concerns of IPC use: demonstrating safety records in patients undergoing chemotherapy15 and local radiotherapy16 with IPC in situ, and no significant protein loss results from regular drainage.17 IPC represents a new therapeutic ideology (not “yet another Catheter”), and clinicians are still adapting to the specific changes needed to realize the full potential of this device. Suzuki et al.8 described a representative single-center review of IPC use, highlighting important contemporary issues of IPC management. First, the exact place of IPC in the paradigm of MPE management has yet to be defined. IPC is generally accepted for treatment of MPE patients in whom pleurodesis has failed or is contraindicated (especially trapped lungs).18 Many specialist centers now offer

Y Gary C Lee - One of the best experts on this subject based on the ideXlab platform.

  • management of malignant Pleural effusions an official ats sts str clinical practice guideline
    American Journal of Respiratory and Critical Care Medicine, 2018
    Co-Authors: David Fellerkopman, Narayan P Iyer, Chakravarthy Reddy, Sandra Zelman Lewis, Rebecca L Diekemper, Michael K Gould, Y Gary C Lee, Malcolm M Decamp, Travis S Henry, Nick A Maskell
    Abstract:

    Background: This Guideline, a collaborative effort from the American Thoracic Society, Society of Thoracic Surgeons, and Society of Thoracic Radiology, aims to provide evidence-based recommendations to guide contemporary management of patients with a malignant Pleural effusion (MPE).Methods: A multidisciplinary panel developed seven questions using the PICO (Population, Intervention, Comparator, and Outcomes) format. The GRADE (Grading of Recommendations, Assessment, Development and Evaluation) approach and the Evidence to Decision framework was applied to each question. Recommendations were formulated, discussed, and approved by the entire panel.Results: The panel made weak recommendations in favor of: 1) using ultrasound to guide Pleural interventions; 2) not performing Pleural interventions in asymptomatic patients with MPE; 3) using either an indwelling Pleural Catheter (IPC) or chemical pleurodesis in symptomatic patients with MPE and suspected expandable lung; 4) performing large-volume thoracentesi...

  • complications of indwelling Pleural Catheter use and their management
    BMJ Open Respiratory Research, 2016
    Co-Authors: Macy Mei Sze Lui, Rajesh Thomas, Y Gary C Lee
    Abstract:

    The growing utilisation of indwelling Pleural Catheters (IPCs) has put forward a new era in the management of recurrent symptomatic Pleural effusions. IPC use is safe compared to talc pleurodesis, though complications can occur. Pleural infection affects <5% of patients, and is usually responsive to antibiotic treatment without requiring Catheter removal or surgery. Pleural loculations develop over time, limiting drainage in 10% of patients, which can be improved with intraPleural fibrinolytic therapy. Catheter tract metastasis can occur with most tumours but is more common in mesothelioma. The metastases usually respond to analgaesics and/or external radiotherapy. Long-term intermittent drainage of exudative effusions or chylothorax can potentially lead to loss of nutrients, though no data exist on any clinical impact. Fibrin clots within the Catheter lumen can result in blockage. Chest pain following IPC insertion is often mild, and adjustments in analgaesics and drainage practice are usually all that are required. As clinical experience with the use of IPC accumulates, the profile and natural course of complications are increasingly described. We aim to summarise the available literature on IPC-related complications and the evidence to support specific strategies.

  • predictors of clinical use of pleurodesis and or indwelling Pleural Catheter therapy for malignant Pleural effusion
    Chest, 2015
    Co-Authors: Nick A Maskell, Edward T H Fysh, Silvia Bielsa, Charley A Budgeon, Catherine A Read, Jose M Porcel, Y Gary C Lee
    Abstract:

    BACKGROUND The clinical course of patients with malignant Pleural effusions (MPEs) varies. The decision to undertake “definitive therapy” (pleurodesis, indwelling Pleural Catheter [IPC], or both) for MPEs is decided on a case-by-case basis. Identifying factors that predict definitive therapy may help guide early initiation of treatment. The aim of the study was to identify clinical, laboratory, and radiologic predictors associated with clinicians' prescription of definitive therapy for patients with MPE. METHODS A multicenter, observational study was conducted over 55 months involving tertiary centers in Perth, Western Australia, Australia, and Lleida, Spain. Demographic, clinical, radiologic, biochemical, and histologic data and the treatments received were recorded. Logistic regression was performed to determine the variables useful for predicting definitive therapy. RESULTS Data of 540 patients (365 from Perth and 184 from Lleida) were analyzed; 537 fulfilled the criteria of an MPE. Definitive therapy was used in 288 patients (53.6'): 199 received a pleurodesis and 89 an IPC. Univariate analysis of the combined cohort revealed that definitive therapy was more likely if the effusion has low pH, either as a continuous variable (OR, 30.30; P P = .03); was large (> 50' of hemithorax) (OR, 2.75; P P P P P = .01) were associated with the use of definitive therapy. CONCLUSIONS Patients with MPE with an effusion of low Pleural fluid pH and large size on radiographs at first presentation are more likely to be treated with pleurodesis and/or IPC.

  • indwelling Pleural Catheter changing the paradigm of malignant effusion management
    Journal of Thoracic Oncology, 2011
    Co-Authors: Y Gary C Lee, Edward T H Fysh
    Abstract:

    Malignant Pleural effusions (MPEs) affect as many as 150,000 patients with cancer in the United States1 and 100,000 patients with lung cancer2 in Europe each year. Inpatient care alone for MPE costs US$6 million per million population in Australia annually (data, the Western Australia Health Dept). The exciting advent of indwelling tunneled Pleural Catheters (IPCs) has critically challenged conventional approaches to MPE management, especially pleurodesis.3 IPCs offer ambulatory fluid drainage as the primary symptomatic therapy, thus prompting clinicians to redefine the goalposts of MPE care. Talc pleurodesis has been the mainstay of MPE management for decades, but its efficacy and safety have recently come under scrutiny.4 In the largest randomized trial in Pleural disease (n 486),5 talc (poudrage or slurry) pleurodesis had a suboptimal success rate: only 75% of MPE patients at 1 month and 50% by 6 months had adequate fluid control. Adding the fact that many patients are unsuitable for pleurodesis (e.g., with trapped lungs), talc pleurodesis benefits only a subset of all MPE patients. Randomized trials have also shown that talc induces lung and systemic inflammation6 and killed 2.3% of patients in a Cancer and Leukemia Group B study through talc-induced respiratory failure.5 Although this acute lung injury can be avoided by using large particle size talc preparations,7 such products are not readily available in many countries, including the United States. These data have provoked debates and compelled the Pleural community to revisit the principles of MPE care. The fundamental aim in MPE management is to improve dyspnea and quality of life, with minimal intervention and hospitalization. The timely introduction of IPCs which allow fluid evacuation from a single minimally invasive procedure serves exactly this purpose and explains its rapid rise in popularity (Suzuki et al estimated that 39,000 units sold in the United States per year8). Suzuki et al.8 in this issue of Journal of Thoracic Oncology reported the largest series of IPC (n 418) experience, providing corroborative evidence that IPCs are safe.9–12 A recent summary of all published reports on IPC complications revealed that most complaints were minor (e.g., mild pain after insertion).13 A systematic review including 1370 patients has confirmed that serious complications, e.g., infection were uncommon ( 3%).14 Other series have addressed specific concerns of IPC use: demonstrating safety records in patients undergoing chemotherapy15 and local radiotherapy16 with IPC in situ, and no significant protein loss results from regular drainage.17 IPC represents a new therapeutic ideology (not “yet another Catheter”), and clinicians are still adapting to the specific changes needed to realize the full potential of this device. Suzuki et al.8 described a representative single-center review of IPC use, highlighting important contemporary issues of IPC management. First, the exact place of IPC in the paradigm of MPE management has yet to be defined. IPC is generally accepted for treatment of MPE patients in whom pleurodesis has failed or is contraindicated (especially trapped lungs).18 Many specialist centers now offer

  • optimal chest drain size the rise of the small bore Pleural Catheter
    Seminars in Respiratory and Critical Care Medicine, 2010
    Co-Authors: Edward T H Fysh, Nicola A Smith, Y Gary C Lee
    Abstract:

    Drainage of the Pleural space is not a modern concept, but the optimal size of chest drains to use remains debated. Conventional teaching advocates blunt dissection and large-bore tubes; but in recent years, small-bore Catheters have gained popularity. In the absence of high-quality randomized data, this review summarizes the available literature on the choice of chest drains. The objective data supporting the use of large-bore tubes is scarce in most Pleural diseases. Increasing evidence shows that small-bore Catheters induce less pain and are of comparable efficacy to large-bore tubes, including in the management of Pleural infection, malignant effusion, and pneumothoraces. The onus now is on those who favor large tubes to produce clinical data to justify the more invasive approach.

Rachelle Asciak - One of the best experts on this subject based on the ideXlab platform.

Liju Ahmed - One of the best experts on this subject based on the ideXlab platform.

  • outpatient talc administration by indwelling Pleural Catheter for malignant effusion
    The New England Journal of Medicine, 2018
    Co-Authors: Rahul Bhatnagar, Mohammed Haris, Richard Harrison, Emma Keenan, Anna J Morley, Brennan C Kahan, Andrew Stanton, Rehan A Mustafa, Lesley Bishop, Liju Ahmed
    Abstract:

    Abstract Background Malignant Pleural effusion affects more than 750,000 persons each year across Europe and the United States. Pleurodesis with the administration of talc in hospitalized patients is the most common treatment, but indwelling Pleural Catheters placed for drainage offer an ambulatory alternative. We examined whether talc administered through an indwelling Pleural Catheter was more effective at inducing pleurodesis than the use of an indwelling Pleural Catheter alone. Methods Over a period of 4 years, we recruited patients with malignant Pleural effusion at 18 centers in the United Kingdom. After the insertion of an indwelling Pleural Catheter, patients underwent drainage regularly on an outpatient basis. If there was no evidence of substantial lung entrapment (nonexpandable lung, in which lung expansion and Pleural apposition are not possible because of visceral fibrosis or bronchial obstruction) at 10 days, patients were randomly assigned to receive either 4 g of talc slurry or placebo thr...

  • optimum a protocol for a multicentre randomised controlled trial comparing out patient talc slurry via indwelling Pleural Catheter for malignant Pleural effusion vs usual inpatient management
    BMJ Open, 2016
    Co-Authors: Alex West, Liju Ahmed, Parthipan Sivakumar, Abdel Douiri, Deepak Rao, Geoffrey Warwick, Tao Chen
    Abstract:

    Introduction The development of malignant Pleural effusion (MPE) results in disabling breathlessness, pain and reduced physical capability with treatment a palliative strategy. Ambulatory management of MPE has the potential to improve quality of life (QoL). The OPTIMUM trial is designed to determine whether full outpatient management of MPE with an indwelling Pleural Catheter (IPC) and pleurodesis improves QoL compared with traditional inpatient care with a chest drain and talc pleurodesis. OPTIMUM is currently open for any centres interested in collaborating in this study. Methods and analysis OPTIMUM is a multicentre non-blinded randomised controlled trial. Patients with a diagnosis of MPE will be identified and screened for eligibility. Consenting participants will be randomised 1:1 either to an outpatient ambulatory pathway using IPCs and talc pleurodesis or standard inpatient treatment with chest drain and talc pleurodesis as per British Thoracic Society guidelines. The primary outcome measure is global health-related QoL at 30 days measured using the EORTC QLQ-C30 questionnaire. Secondary outcome measures include breathlessness and pain measured using a 100 mm Visual Analogue Scale and health-related QoL at 60 and 90 days. A sample size of 142 patients is needed to demonstrate a clinically significant difference of 8 points in global health status at 30 days, for an 80% power and a 5% significance level. Ethics and dissemination The study has been approved by the NRES Committee South East Coast—Brighton and Sussex (reference 15/LO/1018). The trial results will be published in peer-reviewed journals and presented at scientific conferences. Trial registration numbers UKCRN19615 and ISRCTN15503522; Pre-results.

  • safety of indwelling Pleural Catheter use in patients undergoing chemotherapy a five year retrospective evaluation
    BMC Pulmonary Medicine, 2016
    Co-Authors: Liju Ahmed, Parthipan Sivakumar, Charleen Chan Wah Hak
    Abstract:

    Indwelling Pleural Catheters (IPC) are increasingly becoming a first-line treatment in the management of malignant Pleural effusions. Ambulatory management using IPC are increasingly used in this patient group whilst they are receiving concurrent chemotherapy. There are currently no prospective trials examining IPC safety in chemotherapy. This study’s objective is to determine if IPC insertion is safe in patients undergoing chemotherapy. We conducted a retrospective analysis of all patients who underwent IPC insertion for malignant Pleural effusion at our trust from September 2010 to December 2014. Data was collected on IPC insertion and removal, tumour type, systemic chemotherapy, Pleural infection and other complications. One hundred four patients were identified, 43 in chemotherapy group and 61 in non-chemotherapy group. The incidence of Pleural infection in chemotherapy group vs non-chemotherapy group, 4 (9.3 %) vs 3 (4.9 %) respectively, was not statistically different (Fisher’s exact p = 0.311). There was no significant difference in six-month infection-free duration from the date of IPC insertion (log rank p = 0.394). Overall six-month mortality in chemotherapy group was significantly lower than in non-chemotherapy group (log rank p = 0.007). This is the second largest retrospective case–control series that concludes systemic chemotherapy is safe in patients with IPC undergoing chemotherapy.