Indwelling pleural catheters for benign pleural effusions: what is the evidence?

Benign pleural effusions are common and usually managed by treating the underlying disease process. In some patients, these effusions may be refractory to medical management. Indwelling pleural catheters, used extensively for malignant pleural effusions, are increasingly used in benign pleural effusions not responding to medical therapy. This review focuses on current data regarding their safety and effectiveness in effusions due to congestive heart failure, hepatic hydrothorax, end-stage renal disease, and chylothorax. Indwelling pleural catheters are effective and appear well tolerated in congestive heart failure, seem to be associated with a low complication rate and may be considered a reasonable treatment option, particularly for nontransplant candidates. The pleurodesis rate interestingly approaches that of malignant pleural effusions (30-40%). In hepatic hydrothorax, indwelling pleural catheters carry a substantial risk of infectious complications and mortality risk and should be avoided in patients awaiting transplantation, but may be acceptable in the setting of palliation in selected patients intolerant to or poor candidates for other therapeutic options. Data are limited for end-stage renal disease and chylothorax, and therefore, indwelling pleural catheters should only be considered in these situations after a thoughtful multidisciplinary discussion. Indwelling pleural catheters are effective at symptom palliation and have pleurodesis rates comparable to that seen in malignant pleural effusions. However, given the paucity of evidence and low quality of available data, prospective and comparative studies evaluating safety and efficacy in these specific patient populations are needed.