TY - JOUR T1 - Randomised trial of indwelling pleural catheters for refractory transudative pleural effusions JF - European Respiratory Journal JO - Eur Respir J DO - 10.1183/13993003.01362-2021 VL - 59 IS - 2 SP - 2101362 AU - Steven P. Walker AU - Oliver Bintcliffe AU - Emma Keenan AU - Louise Stadon AU - Matthew Evison AU - Mohammed Haris AU - Thapas Nagarajan AU - Alex West AU - Alina Ionescu AU - Benjamin Prudon AU - Anur Guhan AU - Rehan Mustafa AU - Jurgen Herre AU - David Arnold AU - Rahul Bhatnagar AU - Brennan Kahan AU - Robert F. Miller AU - Najib M. Rahman AU - Nick A. Maskell Y1 - 2022/02/01 UR - http://erj.ersjournals.com/content/59/2/2101362.abstract N2 - Objective Refractory symptomatic transudative pleural effusions are an indication for pleural drainage. There has been supportive observational evidence for the use of indwelling pleural catheters (IPCs) for transudative effusions, but no randomised trials. We aimed to investigate the effect of IPCs on breathlessness in patients with transudative pleural effusions when compared with standard care.Methods A multicentre randomised controlled trial, in which patients with transudative pleural effusions were randomly assigned to either an IPC (intervention) or therapeutic thoracentesis (TT; standard care). The primary outcome was mean daily breathlessness score over 12 weeks from randomisation.Results 220 patients were screened from April 2015 to August 2019 across 13 centres, with 33 randomised to intervention (IPC) and 35 to standard care (TT). Underlying aetiology was heart failure in 46 patients, liver failure in 16 and renal failure in six. In primary outcome analysis, the mean±sd breathlessness score over the 12-week study period was 39.7±29.4 mm in the IPC group and 45.0±26.1 mm in the TT group (p=0.67). Secondary outcomes analysis demonstrated that mean±sd drainage was 17 412±17 936 mL and 2901±2416 mL in the IPC and TT groups, respectively. A greater proportion of patients had at least one adverse event in the IPC group (p=0.04).Conclusion We found no significant difference in breathlessness over 12 weeks between IPCs or TT. TT is associated with fewer complications and IPCs reduced the number of invasive pleural procedures required. Patient preference and circumstances should be considered in selecting the intervention in this cohort.In the first randomised trial on refractory transudative pleural effusions, indwelling pleural catheters did not offer superior control of breathlessness compared to as required therapeutic thoracentesis https://bit.ly/36mR54x ER -