title: Management of Benign Pleural Effusions Using Indwelling Pleural Catheters: A Systematic Review and Meta-analysis.
abstract: BACKGROUND
  The indwelling pleural catheter (IPC), which was initially introduced for the management of recurrent malignant effusions, could be a valuable management option for recurrent benign pleural effusion (BPE), replacing chemical pleurodesis. The purpose of this study is to analyze the efficacy and safety of IPC use in the management of refractory nonmalignant effusions.
  
  
  METHODS
  We conducted a systematic review and meta-analysis on the published literature. Retrospective cohort studies, case series, and reports that used IPCs for the management of pleural effusion were included in the study.
  
  
  RESULTS
  Thirteen studies were included in the analysis, with a total of 325 patients. Congestive heart failure (49.8%) was the most common cause of BPE requiring IPC placement. The estimated average rate of spontaneous pleurodesis was 51.3% (95% CI, 37.1%-65.6%). The estimated average rate of all complications was 17.2% (95% CI, 9.8%-24.5%) for the entire group. The estimated average rate of major complications included the following: empyema, 2.3% (95% CI, 0.0%-4.7%); loculation, 2.0% (95% CI, 0.0%-4.7%); dislodgement, 1.3% (95% CI, 0.0%-3.7%); leakage, 1.3% (95% CI, 0.0%-3.5%); and pneumothorax, 1.2% (95% CI, 0.0%-4.1%). The estimated average rate of minor complications included the following: skin infection, 2.7% (95% CI, 0.6%-4.9%); blockage and drainage failure, 1.1% (95% CI, 0.0%-3.5%); subcutaneous emphysema, 1.1% (95% CI, 0.0%-4.0%); and other, 2.5% (95% CI, 0.0%-5.2%). One death was directly related to IPC use.
  
  
  CONCLUSIONS
  IPCs are an effective and viable option in the management of patients with refractory BPE. The quality of evidence to support IPC use for BPE remains low, and high-quality studies such as randomized controlled trials are needed.
authors.affiliation: Department of Pulmonary, Critical Care and Sleep Medicine, State University of New York (SUNY) at Buffalo, Buffalo, NY.
authors.forename: Monali
authors.initials: M
authors.lastname: Patil
authors.affiliation: Department of Pulmonary, Critical Care and Sleep Medicine, State University of New York (SUNY) at Buffalo, Buffalo, NY; Department of Medicine, Pulmonary Medicine, and Interventional Pulmonary Section, Roswell Park Cancer Institute, Buffalo, NY.
authors.forename: Samjot Singh
authors.initials: SS
authors.lastname: Dhillon
authors.affiliation: Department of Biostatistics and Bioinformatics, Roswell Park Cancer Institute, Buffalo, NY.
authors.forename: Kristopher
authors.initials: K
authors.lastname: Attwood
authors.affiliation: Department of Internal Medicine, State University of New York (SUNY) at Buffalo, Buffalo, NY.
authors.forename: Marwan
authors.initials: M
authors.lastname: Saoud
authors.affiliation: Department of Pulmonary, Critical Care and Sleep Medicine, State University of New York (SUNY) at Buffalo, Buffalo, NY; Department of Medicine, Pulmonary Medicine, and Interventional Pulmonary Section, Roswell Park Cancer Institute, Buffalo, NY.
authors.forename: Abdul Hamid
authors.initials: AH
authors.lastname: Alraiyes
authors.affiliation: Department of Pulmonary, Critical Care and Sleep Medicine, State University of New York (SUNY) at Buffalo, Buffalo, NY; Department of Medicine, Pulmonary Medicine, and Interventional Pulmonary Section, Roswell Park Cancer Institute, Buffalo, NY. Electronic address: kassemharris@gmail.com.
authors.forename: Kassem
authors.initials: K
authors.lastname: Harris
mesh_terms: D002408:Catheters, Indwelling; D004322:Drainage; D016724:Empyema, Pleural / Q000453:epidemiology; D005548:Foreign-Body Migration / Q000453:epidemiology; D006801:Humans; D010996:Pleural Effusion / Q000601:surgery*; D011030:Pneumothorax / Q000453:epidemiology
keywords: benign pleural effusion; indwelling pleural catheter; pleurodesis