Department of Thoracic Surgery and Interventional Pulmonology, Swedish Cancer Institute, Seattle, WA.
Division of Pulmonary and Critical Care, Duke University, Durham, NC.
Chest. 2020 Nov;158(5):2221-2228. doi: 10.1016/j.chest.2020.05.594. Epub 2020 Jun 17.
The management of recurrent pleural effusions remains a challenging issue for clinicians. Advances in management have led to increased use of indwelling tunneled pleural catheters (IPC) because of their effectiveness and ease of outpatient placement. However, with the increase in IPC placement there have also been increasing reports of complications, including infections. Currently there is minimal guidance in IPC-related management issues after placement.
Our objective was to formulate clinical consensus statements related to perioperative and long-term IPC catheter management based on a modified Delphi process from experts in pleural disease management.
Expert panel members used a modified Delphi process to reach consensus on common perioperative and long-term management options related to IPC use. Members were identified from multiple countries, specialties, and practice settings. A series of meetings and anonymous online surveys were completed. Responses were used to formulate consensus statements among panel experts, using a modified Delphi process. Consensus was defined a priori as greater than 80% agreement among panel constituents.
A total of 25 physicians participated in this project. The following topics were addressed during the process: definition of an IPC infection, management of IPC-related infectious complications, interventions to prevent IPC infections, IPC-related obstruction/malfunction management, assessment of IPC removal, and instructions regarding IPC management by patients and caregivers. Strong consensus was obtained on 36 statements. No consensus was obtained on 29 statements.
The management of recurrent pleural disease with IPC remains complex and challenging. This statement offers statements for care in numerous areas related to IPC management based on expert consensus and identifies areas that lack consensus. Further studies related to long-term management of IPC are warranted.
复发性胸腔积液的治疗仍是临床医生面临的挑战。由于留置胸腔引流管（IPC）在疗效和门诊置管方面的优势，其应用逐渐增多，管理水平也有所提高。然而，随着 IPC 置管数量的增加，相关并发症，包括感染的报道也越来越多。目前，IPC 置管后相关管理问题的指导意见很少。
我们的目的是通过胸膜疾病管理专家的改良 Delphi 流程，制定与围手术期和长期 IPC 导管管理相关的临床共识声明。
专家小组通过改良 Delphi 流程，就与 IPC 使用相关的常见围手术期和长期管理选择达成共识。小组成员来自多个国家、专业和实践环境。完成了一系列会议和匿名在线调查。使用改良 Delphi 流程，根据小组成员的反馈制定共识声明。共识定义为小组参与者达成 80%以上的共识。
共有 25 名医生参与了该项目。该过程中讨论了以下主题：IPC 感染的定义、IPC 相关感染性并发症的处理、预防 IPC 感染的干预措施、IPC 相关阻塞/故障管理、IPC 移除评估以及患者和护理人员的 IPC 管理说明。36 项声明获得了强烈共识，29 项声明未达成共识。
使用 IPC 治疗复发性胸膜疾病仍然复杂且具有挑战性。本声明基于专家共识为 IPC 管理的众多领域提供了护理建议，并确定了缺乏共识的领域。需要进一步研究 IPC 的长期管理。
