Adjunct strategies to enhance the efficacy of indwelling pleural catheters

Malignant pleural effusion remains a distressing and unfortunately common occurrence. Pleural palliation should be focused on relieving dyspnea with as few procedures as possible. The introduction of the indwelling tunneled pleural catheter has been shown to fulfill these goals; however, it is not without limitations. The ability to potentially combine the results of a long-term pleurodesis procedure without the need for a prolonged hospitalization remains an attractive option. While no large-scale trials have been completed nor is there widespread acceptance, the introduction of “rapid” or “accelerated” pleurodesis procedures, often using tunneled indwelling pleural catheters, have the potential to significantly change the current paradigm of malignant pleural effusion management. This article reviews the current data available for “rapid” and “accelerated” pleurodesis protocols and their outcomes.