Introduction: The optimal drainage protocol for indwelling pleural catheters (IPCs) inserted for malignant pleural effusions needs to be individually tailored to patients? needs. Although daily drainage is associated with increased autopleurodesis rates, it is not cost-effective. We sought to evaluate the efficacy of symptom-guided pleural drainage in our cohort of patients with IPCs. 

Aim: To evaluate the effectiveness of symptom-guided drainage of pleural fluid in achieving autopleurodesis in a cohort of Singaporean patients with IPCs inserted for malignant pleural effusions.

Method: Longitudinal observational study of patients with IPCs inserted for malignant pleural effusions in Changi General Hospital Singapore between 1 January 2017 ? 31 December 2022. IPCs were drained intermittently when patients develop symptoms from accumulation of pleural fluid. Baseline characteristics, method of drainage and outcomes were collected.

Results: 39 patients were followed up for a median of 3 months (interquartile range 2-5 months). Age was 71±16 years, 20 (51.3%) were male. Most common aetiologies of malignant pleural effusion were lung (79.5%) and gastrointestinal (5.1%) cancers. Autopleurodesis rate was 59.0%. Median time to autopleurodesis was 117±98 days. Any adverse event occurred in 12 patients (30.8%). The most common were pleural infection (15.4%) and catheter blockage (12.8%).

Conclusions: Among patients with IPCs for malignant pleural effusions, intermittent drainage of pleural fluid when symptomatic is associated with high rates of autopleurodesis, but associated with longer time to liberation from IPC, and higher rates of adverse events.