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Southwest Pulmonary and Critical Care Fellowships

Pulmonary Journal Club

(Click on title to be directed to posting, most recent listed first)

May 2017 Phoenix Pulmonary/Critical Care Journal Club
October 2015 Phoenix Pulmonary Journal Club: Lung Volume Reduction
September 2015 Tucson Pulmonary Journal Club: Genomic Classifier
   for Lung Cancer
April 2015 Phoenix Pulmonary Journal Club: Endo-Bronchial Ultrasound in
   Diagnosing Tuberculosis
February 2015 Tucson Pulmonary Journal Club: Fibrinolysis for PE
January 2015 Tucson Pulmonary Journal Club: Withdrawal of Inhaled
    Glucocorticoids in COPD
January 2015 Phoenix Pulmonary Journal Club: Noninvasive Ventilation In 
   Acute Respiratory Failure
September 2014 Tucson Pulmonary Journal Club: PANTHEON Study
June 2014 Tucson Pulmonary Journal Club: Pirfenidone in Idiopathic
   Pulmonary Fibrosis
September 2014 Phoenix Pulmonary Journal Club: Inhaled Antibiotics
August 2014 Phoenix Pulmonary Journal Club: The Use of Macrolide
   Antibiotics in Chronic Respiratory Disease
June 2014 Phoenix Pulmonary Journal Club: New Therapies for IPF
   and EBUS in Sarcoidosis
March 2014 Phoenix Pulmonary Journal Club: Palliative Care
February 2014 Phoenix Pulmonary Journal Club: Smoking Cessation
January 2014 Pulmonary Journal Club: Interventional Guidelines
December 2013 Tucson Pulmonary Journal Club: Hypothermia
December 2013 Phoenix Pulmonary Journal Club: Lung Cancer
   Screening
November 2013 Tucson Pulmonary Journal Club: Macitentan
November 2013 Phoenix Pulmonary Journal Club: Pleural Catheter
   Infection
October 2013 Tucson Pulmonary Journal Club: Tiotropium Respimat 
October 2013 Pulmonary Journal Club: Pulmonary Artery
   Hypertension
September 2013 Pulmonary Journal Club: Riociguat; Pay the Doctor
August 2013 Pulmonary Journal Club: Pneumococcal Vaccine
   Déjà Vu
July 2013 Pulmonary Journal Club
June 2013 Pulmonary Journal Club
May 2013 Pulmonary Journal Club
March 2013 Pulmonary Journal Club
February 2013 Pulmonary Journal Club
January 2013 Pulmonary Journal Club
December 2012 Pulmonary Journal Club
November 2012 Pulmonary Journal Club
October 2012 Pulmonary Journal Club
September 2012 Pulmonary Journal Club
August 2012 Pulmonary Journal Club
June 2012 Pulmonary Journal Club
June 2012 Pulmonary Journal Club
May 2012 Pulmonary Journal Club
April 2012 Pulmonary Journal Club
March 2012 Pulmonary Journal Club
February 2012 Pulmonary Journal Club
January 2012 Pulmonary Journal Club
December 2011 Pulmonary/Sleep Journal Club
October, 2011 Pulmonary Journal Club
September, 2011 Pulmonary Journal Club
August, 2011 Pulmonary Journal Club
July 2011 Pulmonary Journal Club
May, 2011 Pulmonary Journal Club
April, 2011 Pulmonary Journal Club
February 2011 Pulmonary Journal Club 
January 2011 Pulmonary Journal Club 
December 2010 Pulmonary Journal Club

 

Both the Phoenix Good Samaritan/VA and the Tucson University of Arizona fellows previously had a periodic pulmonary journal club in which current or classic pulmonary articles were reviewed and discussed. A brief summary was written of each discussion describing thearticle and the strengths and weaknesses of each article.

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Entries in tunneled pleural catheter (1)

Saturday
Nov302013

November 2013 Phoenix Pulmonary Journal Club: Pleural Catheter Infection

Fysh ET, Tremblay A, Feller-Kopman D, Mishra EK, Slade M, Garske L, Clive AO, Lamb C, Boshuizen R, Ng BJ, Rosenstengel AW, Yarmus L, Rahman NM, Maskell NA, Lee YC. Clinical outcomes of indwelling pleural catheter-related pleural infections: an international multicenter study. Chest. 2013;144(5):1597-602. [CrossRef] [PubMed]

Tunneled indwelling pleural catheters (TPC) have revolutionized the treatment of recurrent malignant pleural effusions. Malignant pleural effusions are seen in up to 15% of advanced malignancies such as lung and breast cancer. Prior to the approval of TPC, treatment options were limited to mechanical or chemical pleurodesis. The FDA approved the use of TPC for the treatment of malignant pleural effusions (MPE) in 1997. The study published by Putnam, Light et al. (1) validated the use of tunneled pleural catheters in the management of malignant pleural effusions. Over the last decade the use of TPC has escalated. This retrospective study looks at the number of reported cases of tunneled pleural catheter related infections.

The study was a retrospective chart review of done through 11 centers from the years 2001-2012. A total of 1021 patients and catheters were placed during this time frame for the management of MPE. Catheter related infections were defined by having bacteria or pus present in the pleural fluid, having signs and symptoms of infection and the need for antibiotics. The study also identified what the common pathogens were and how infections were managed.

The results showed that the rate of TPC infections were low at 4.9% (50 cases). The median duration from time of catheter insertion until infection was 62 days. The most common pathogen was methicillin sensitive Staphylococcus aureus (48%) followed by gram negatives (18%). The majority of the patients (37patients) required admission to the hospital for intravenous antibiotics while the others were treated in the home setting. The median duration of antibiotic administration was 24 days.  Intra-pleural fibrinolytics were used in 13 patients and 23 patients had their TPC removed. None of the patients required surgery and there were 3 deaths attributed to infection of the TPC.

This large retrospective cohort study yields the largest collection of data on infection rates in the setting of TPC. There are several limitations to the study but the main one is the lack of identifying drainage technique and place. In our practice setting we have noted no TPC infections over the last 5 years when drainage was performed by a home health nurse or within the office setting.  We have noted an increased incidence of TPC infections when drainage was done by the patients themselves or by family members. The study does reinforce that TPC remain a safe and less invasive way to manage MPE. Infections are not that common and in most cases can be managed with antibiotics alone.

Manoj Mathew, MD FCCP MCCM

Reference

  1. Putnam JB Jr, Light RW, Rodriguez RM, Ponn R, Olak J, Pollak JS, Lee RB, Payne DK, Graeber G, Kovitz KL. A randomized comparison of indwelling pleural catheter and doxycycline pleurodesis in the management of malignant pleural effusions. Cancer. 1999;86(10):1992-9. [CrossRef] [PubMed] 

Reference as: Mathew M. November 2013 Phoenix pulmonary journal club: pleural catheter infection. Southwest J Pulm Crit Care. 2013;7(5):316-7. doi: http://dx.doi.org/10.13175/swjpcc171-13 PDF