Pleural catheter plus.

Plus talc, of course. Now that we’ve had AMPLE time to consider using an indwelling pleural catheter for malignant pleural effusion to shorten hospitalization times and lessen interventions, we’ve got new results to ponder. The IPC-Plus trial reports on the efficacy using the indwelling pleural catheter to administer talc in the outpatient setting. 154 participants with malignant effusion had placement of a pleural catheter followed by a series of drainages. They were then randomized to talc infusion versus placebo 10 days post-placement. The primary outcome of successful pleurodesis (<50 cc output or <25% hemithorax radiographic opacification) was significantly higher with talc (23 → 43%). Patients with talc also had about one-third the amount of fluid output (1300 vs 3600 cc). TBL: The results of the AMPLE and IPC-Plus trials suggest that placement of an indwelling pleural catheter followed by administration of talc results in optimal pleurodesis of malignant effusions. | Bhatnagar, N Engl J Med 2018