Original articles
Usefulness of thoracic ultrasound in the assessment of removal of indwelling pleural catheter in patients with malignant pleural effusion
Validación de la ecografía torácica en la valoración de la retirada del catéter pleural tunelizado ambulatorio en pacientes con un derrame pleural maligno
M. Iglesias Herasa,
, E. Juárez Morenob, J. Ortiz de Saracho Bobob, J. Cascón Hernándezc, J.M. Fernández García-Hierrod, E. Yagüe Zapateroe, R. Cordovilla Péreza
Corresponding author
a Servicio de Neumología, Hospital Universitario de Salamanca, Salamanca. Spain
b Servicio de Neumología, Hospital El Bierzo, Ponferrada, León, Spain
c Servicio de Neumología, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
d Servicio de Radiodiagnóstico, Hospital Universitario de Salamanca, Salamanca, Spain
e Servicio de Radiodiagnóstico, Hospital El Bierzo, Ponferrada, León, Spain
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Iglesias Heras, E. Juárez Moreno, J. Ortiz de Saracho Bobo, J. Cascón Hernández, J.M. Fernández García-Hierro, E. Yagüe Zapatero, R. Cordovilla Pérez" "autores" => array:7 [ 0 => array:4 [ "nombre" => "M." "apellidos" => "Iglesias Heras" "email" => array:1 [ 0 => "miglesiash@saludcastillayleon.es" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "E." "apellidos" => "Juárez Moreno" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "J." "apellidos" => "Ortiz de Saracho Bobo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "J." 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Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Neumología, Hospital El Bierzo, Ponferrada, León, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Neumología, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Servicio de Radiodiagnóstico, Hospital Universitario de Salamanca, Salamanca, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "Servicio de Radiodiagnóstico, Hospital El Bierzo, Ponferrada, León, Spain" "etiqueta" => "e" "identificador" => "aff0025" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Validación de la ecografía torácica en la valoración de la retirada del catéter pleural tunelizado ambulatorio en pacientes con un derrame pleural maligno" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 1388 "Ancho" => 2083 "Tamanyo" => 159102 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0020" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Patient selection flowchart. We assessed 41 non-draining IPCs. Twenty-two are removed due to lung re-expansion, and another by the patient's decision. Eighteen patients entered the study, all of whom underwent ultrasound by a pulmonologist and chest CT, and 11 underwent ultrasound by a radiologist. IPC: indwelling pleural catheter.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Malignant pleural effusion (MPE) is one of the most common causes of pleural exudate, and its incidence is rising in line with the increased prevalence of neoplastic diseases and the longer people are living with them.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> The presence of MPE usually indicates that the neoplastic disease has spread, the most common aetiology being bronchogenic carcinoma in men and breast carcinoma in women.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,3</span></a> MPE may be observed in up to 50% of lung cancer cases, and is present in 15% of these cases at diagnosis,<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> signifying an advanced stage of the disease with a median survival of between 3 and 12 months.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> This, added to the fact that most patients are symptomatic, with dyspnoea being the most frequent symptom,<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> means that the primary objectives in the management of MPE are symptom control and quality of life.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Various palliative techniques have been developed for this purpose,<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> including the indwelling pleural catheter (IPC), which improves symptoms in 96% of patients,<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> and improves their quality of life.<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5,6</span></a> IPCs can be as effective as talc pleurodesis in relieving the symptoms of MPE, but with shorter hospitalisation time<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> and fewer repeat interventions.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> Another advantage is that it can be used in patients with trapped lung, as it does not require lung re-expansion to achieve its goal.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9,10</span></a> The latest clinical practice guidelines from the American Thoracic Society (ATS) recommend both IPC or talc pleurodesis equally for the management of MPE with an expandable lung and IPC for a non-expandable lung.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">One of the key attributes of IPC is its ability to produce pleurodesis in up to 46% of cases<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> without the need for a sclerosing agent which leads to the removal of the IPC in between 28% and 56% of cases.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> However, Bhatnagar et al. found a higher probability of pleurodesis by adding talc administration through the IPC, without any additional complications.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">It seems obvious that IPCs can be removed when pleural fluid does not re-accumulate and full lung re-expansion has been achieved. However, there are no clinical or radiological criteria in the literature that clearly define the point at which spontaneous pleurodesis (SP) is achieved nor the ideal time to remove the drain. Thus, the definition of SP most frequently referred to in the literature, including studies by Tremblay et al.,<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> Davies et al.,<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> Lorenzo et al.,<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> Warren et al.,<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> and Mitchell et al.,<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> states that SP is considered to be achieved when less than 50 cc is drained in one day or 100 cc on alternate days, there is no recurrent effusion and symptoms are under control. In a 2017 review of the use of IPC in trapped lung, Bertolaccini et al.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a>, defined it as the long-lasting relief of symptoms and absence of fluid accumulation on chest radiograph. They recommended the removal of the IPC when drainage is not required within one month and there is no significant effusion on radiograph. Asciak and Rahman are not as specific in the definition they provide in their 2017 review in <span class="elsevierStyleItalic">Clinics In Chest Medicine</span>,<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> in which they allow the removal of IPC once there is no evidence of effusion recurrence.</p><p id="par0025" class="elsevierStylePara elsevierViewall">In clinical practice, this lack of specific criteria for removal does not affect those patients whose chest radiographs can clearly assess complete lung re-expansion or the presence of a significant pleural effusion. Difficulties arise in cases where additional imaging tests are required to define the amount of pleural fluid, its loculations and the exact location of the IPC within the pleural cavity. For this purpose, the most commonly used imaging test is computed tomography (CT) of the chest, which enables exploration of the pleural effusion and the location of the IPC. But the difficulties involved in the implementation together with the delays, radiation, expense and need for continuous visits by the patient to the hospital are well documented and affect decision making regarding removal.</p><p id="par0030" class="elsevierStylePara elsevierViewall">In 2014, Ahmed et al. published a study in <span class="elsevierStyleItalic">Chest</span> on talc pleurodesis by means of IPC, which used chest ultrasound to determine lung expansion had occurred when five out of six thoracic areas explored demonstrated satisfactory apposition of the visceral and parietal pleura. In ambiguous cases, they turned to chest CT, but they did not validate or compare the two tests.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> Bhatnagar et al.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> published a study in 2018 evaluating talc administration by means of IPC, in which they defined pleurodesis—in this case non-spontaneous given that they used a symphyseal product—when two criteria were met: less than 50 cc drained in three consecutive attempts and less than 25% opacification due to effusion on chest radiograph. The same publication, while considering the definition to be pragmatic, is unable to assess actual adhesion and therefore recommends the use of ultrasound. Chaddha et al.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> have recently published a study, with data collected after ours, that aimed to assess whether ultrasound can be used to predict pleurodesis after IPC removal, and which suggests that it can identify patients who will not relapse within three months.</p><p id="par0035" class="elsevierStylePara elsevierViewall">The aim of our study is to assess the usefulness of ultrasound performed by a pulmonologist when determining whether or not to remove a catheter, and compare it with the gold standard test, chest CT.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Patients and methods</span><p id="par0040" class="elsevierStylePara elsevierViewall">We designed ECOPleurX, a prospective, descriptive, observational, double-blind, multidisciplinary (specialists in pulmonology and diagnostic radiology) and multicentre study. Permission was sought prior to the study from the Clinical Research Commissions of each hospital centre. The following departments participated in the study: Pulmonology Services of the University Hospitals of Salamanca, El Bierzo (Ponferrada, León), Ávila, Segovia and Zamora and the Diagnostic Radiology Departments of the University Hospital of Salamanca and the Hospital El Bierzo. All centres were able to recruit patients with IPC, and complementary tests were only performed at the Salamanca and El Bierzo centres to make decisions regarding the removal of the IPC.</p><p id="par0045" class="elsevierStylePara elsevierViewall">We used consecutive sampling to include all patients with non-draining IPCs who were assessed for removal between June 2015 and December 2018. All patients were informed about the study and signed the informed consent form.<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">-</span><p id="par0050" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Inclusion criteria</span>: patients with non-draining IPC to control MPE, and lung re-expansion on chest radiograph <80%.</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">-</span><p id="par0055" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Exclusion criteria:</span><ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">•</span><p id="par0060" class="elsevierStylePara elsevierViewall">Lung re-expansion on chest radiograph >80%.</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">•</span><p id="par0065" class="elsevierStylePara elsevierViewall">Patients whose performance status and/or survival did not permit follow-up and necessary procedures.</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">•</span><p id="par0070" class="elsevierStylePara elsevierViewall">Impossibility to perform ultrasound or chest CT.</p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">•</span><p id="par0075" class="elsevierStylePara elsevierViewall">Patient’s refusal.</p></li></ul></p></li></ul></p><p id="par0080" class="elsevierStylePara elsevierViewall">It is considered that the IPC is no longer draining if it does not drain fluid even after it is flushed with sterile saline (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">The first visit, the inclusion visit, was used to confirm that no pleural fluid was being drained through the IPC and to assess the level of dyspnoea. It was also used to perform a PA and lateral chest radiograph. If the chest radiograph showed ≥80% lung re-expansion and the patient had no dyspnoea caused by the effusion, we assumed that spontaneous pleurodesis had been achieved. If no such re-expansion was observed, a chest CT scan was requested (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0090" class="elsevierStylePara elsevierViewall">During the second visit, an ultrasound was performed by a pulmonologist from the interventional pulmonology unit with more than five years of experience in chest ultrasonography and who was responsible for making the decision on whether or not to remove the IPC. A radiologist from the chest unit carried out another ultrasound followed by a CT scan of the chest. Neither physician was aware of the other’s findings, and chest CT was always the final test to be performed. Ultrasound examinations were performed with convex probes at frequencies of between 3.5 and 5 MHz with the patient seated for the posterior thoracic approach. For the chest CT scan, intravenous contrast was administered.</p><p id="par0095" class="elsevierStylePara elsevierViewall">The pulmonologist made the decision about the patient based on the ultrasound data (decision 1), while the radiologist reported their ultrasound findings and recommended a therapeutic approach (decision 2). Finally, the CT scan findings were revealed, and the final decision was made on the basis of the findings of both the chest ultrasound and the CT scan (decision 3).</p><p id="par0100" class="elsevierStylePara elsevierViewall">The following variables were analysed: gender, age, presence of SP (defined as the absence of a significant pleural effusion on both chest ultrasound and CT), characteristics of the effusion (echogenicity, visually estimated quantity and loculations), whether or not the IPC was located within the effusion, and the decision on whether or not to remove the drain according to the above assumptions (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>).</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0105" class="elsevierStylePara elsevierViewall">The decision made on the basis of the data obtained from the chest CT and the patient's symptoms was used as the gold standard (decision 3).</p><p id="par0110" class="elsevierStylePara elsevierViewall">The SPSS® version 20 statistical package was used for statistical analysis. For the qualitative variables, 2 × 2 contingency tables were made. We calculated the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and positive/negative likelihood ratios (LR+/LR−) of the chest ultrasound. We also calculated the kappa index between decision 1 and decision 2. Due to the small sample size, multivariate analysis was not possible (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0115" class="elsevierStylePara elsevierViewall">We assessed a total of 41 IPCs that met the criteria of non-draining. Of these, 23 were excluded from the study because chest radiographs showed lung re-expansion >80% in 22 cases and one patient opted to remove the IPC. The remaining 18 went on to form our sample. In 11 cases, chest ultrasound was performed by both the pulmonologist and the radiologist, as well as a chest CT. In seven cases, no radiologist was available to perform an ultrasound (<a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>).</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0120" class="elsevierStylePara elsevierViewall">Thus, chest ultrasound was performed in 18 cases by a pulmonologist. Of these, 13 (72%) revealed a pleural effusion and five (28%) showed no significant pleural effusion. Loculated and/or septated effusions were observed in 12 cases (92% of the ultrasound scans with effusion), compared to only one case that did not. The IPC was located within the effusion (whether significant or not) in 10 cases (55%).</p><p id="par0125" class="elsevierStylePara elsevierViewall">In the 11 cases in which a chest ultrasound was performed by a radiologist, an effusion was detected in seven cases (64%) while no significant effusion was observed in the remaining four (36%). Septations were observed within all seven effusion cases. Regarding the location of the drain, it was found to be correctly placed within the pleural effusion in five cases (45%) (<a class="elsevierStyleCrossRef" href="#fig0025">Fig. 5</a>).</p><elsevierMultimedia ident="fig0025"></elsevierMultimedia><p id="par0130" class="elsevierStylePara elsevierViewall">Prior to the final decision on whether or not to remove the IPC (decision 3), taken by the pulmonologist on the basis of the results of the chest CT, another decision (decision 1) was made on the basis of the findings of the chest ultrasound. Decision 1 would see the IPC removed in 10 cases (56%) and maintained in eight cases (44%). In contrast, according to decision 3, the IPC would be removed in 14 cases (78%), and maintained in four (22%). When comparing the decisions, in all four cases in which the IPC was left in place according to the final decision (decision 3), this result coincided with decision 1. Meanwhile, of the 14 cases in which the decision was made to remove the IPC in decision 3, the pulmonologist would also remove it in 10 cases (71%) in decision 1, while leaving the IPC in the remaining four cases (29%), resulting in conflicting decisions (<a class="elsevierStyleCrossRef" href="#fig0030">Fig. 6</a>).</p><elsevierMultimedia ident="fig0030"></elsevierMultimedia><p id="par0135" class="elsevierStylePara elsevierViewall">When considering the CT findings as the gold standard, the decision made by the pulmonologist using ultrasound yields sensitivity values of 60% and a specificity of 100%, with a PPV of 100% and NPV of 66% (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>). The calculated LR− would be 0.4 and the LR+ is incalculable given the 100% specificity.</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0140" class="elsevierStylePara elsevierViewall">When analysing the data based on the decision made by a radiologist after CU (11 cases), we obtained absolute concordance as the decision coincided in all cases (kappa index 1) (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>).</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0145" class="elsevierStylePara elsevierViewall">If we compare the ultrasound findings with those of the chest CT, we can see that in the five cases in which no effusion was detected on ultrasound, no significant pleural effusion was detected on chest CT either. Also, in the 12 cases in which an effusion was detected on ultrasound, this was also present on CT. However, the characteristics of these pleural effusions varied on CT: Four of them were loculated with the IPC placed outside the effusion, another four had loculated pleural effusions with the IPC placed correctly inside the effusion, and the last four had free fluid with the IPC correctly placed inside. Coincidentally, the four cases in which the IPC was not located in the pleural effusion were those in which the decisions to remove differed. With these data, we obtain a specificity of 100%, a NPV of 66% and an LR− of 0.4 for determining the presence of SP when pleural effusion is observed on chest ultrasound.</p><p id="par0150" class="elsevierStylePara elsevierViewall">All patients whose IPCs were removed were clinically followed up by both the pleura unit of the pulmonology department and the oncology department, with no MPE recurrence in any case.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0155" class="elsevierStylePara elsevierViewall">Our study is the first to analyse whether chest ultrasound is valid for determining whether or not to remove a non-draining IPC and it uses chest CT as the gold standard. The literature includes an analysis of the capacity of ultrasound to predict pleurodesis at the point of IPC removal by Chaddha et al.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> in which they demonstrate that the proportion of adherent pleural surface area can be calculated using a pleural adhesion index. In contrast to our study, they consider as confirmation of pleurodesis the absence of effusion recurrence within three months.</p><p id="par0160" class="elsevierStylePara elsevierViewall">With our data, the concordance between chest CT and ultrasound (both performed by a pulmonologist and a radiologist), was perfect in those cases in which it was decided to remove the IPC due to spontaneous pleurodesis, with a PPV of 100% and an incalculable LR+. This concordance allows us, as in the majority of cases (10 of the 18 in the study), to confirm the presence of spontaneous pleurodesis with the same certainty that we would obtain from chest CT, but with increased convenience, speed and efficiency.</p><p id="par0165" class="elsevierStylePara elsevierViewall">However, problems arise when an effusion is detected on ultrasound. It is in situations where IPCs are no longer draining but pleural effusion persists, that chest ultrasound is less effective in differentiating between those patients whose IPC is no longer functioning because the catheter is obstructed or the effusion is too dense or loculated to be evacuated, and those with IPCs that have been placed externally to a loculated effusion due to irregular pleurodesis. Thus, in our study, the concordance in cases where an effusion was observed is only moderate (NPV of 66% and LR− of 0.4), indicating that the localisation of an effusion by ultrasound alone does not imply the absence of spontaneous pleurodesis or the need to maintain the IPC. It goes without saying that chest CT allows us to obtain more information on the position of the catheter, the number and exact size of the loculations within the effusion. What should also be mentioned is that the same discordance was observed between the radiologist’s ultrasound results and the same CT findings, so the discordance is not due to the observer and any possible lack of training. In the four cases in which there was discordance between tests, the situation was similar: patients with multiple loculations, one of which was of moderate size, with the pleural catheter located outside this effusion. In addition to this, concordance was higher in the ultrasound examinations in which the catheter was observed inside the pleural effusion. Of the 10 cases in which the catheter was located, the decision was the same in nine cases with a concordance of 90%. This could be considered a variable in later studies with a larger number of patients. As an aside, since this was not the subject of the study, all patients who had their IPC removed were subsequently followed up, and in no cases was there any recurrence of MPE.</p><p id="par0170" class="elsevierStylePara elsevierViewall">Finally, there was complete agreement between the tests performed by an interventional pulmonologist with experience in chest ultrasonography and a radiologist, with both encountering the same limitations. This reaffirms to us the validity of the pulmonologist using ultrasound when deciding whether to not to remove an IPC as part of the clinical procedure and in the same unit.</p><p id="par0175" class="elsevierStylePara elsevierViewall">There are several limitations to our study. Firstly, the test chosen as gold standard was selected because in routine practice it is the imaging test that provides the most information, but it is obviously not perfect in confirming the presence of spontaneous pleurodesis, as we use indirect measurements. Therefore, it is possible that we are wrongly considering patients to be suitable for IPC removal, or vice versa. Moreover, given that the prevalence of non-draining IPCs is relatively low, and that even fewer cases require additional imaging tests other than chest radiography, the number of cases is too small and does not allow us to draw conclusions with sufficient statistical value. Another limitation to take into account when extrapolating the results is that the chest ultrasound scans were performed by interventional pulmonologists who are experienced in managing these scans and IPCs, which may mean that their validity in other settings may be limited if the professionals have less experience.</p><p id="par0180" class="elsevierStylePara elsevierViewall">Taking into account the limitations mentioned above, we can conclude, firstly, that ultrasound is an excellent diagnostic tool for assessing pleural adhesion and the absence of pleural effusion. Secondly, with a more clinical approach, chest ultrasound performed by an experienced pulmonologist is a simple, valid, precise and useful tool to determine the presence of spontaneous pleurodesis and whether or not a non-draining IPC should be removed. This is obviously not necessary when complete lung re-expansion is clearly visible on chest radiograph, but it would obviate the need for a chest CT in those cases in which such re-expansion is visible on ultrasound. Further studies with larger sample sizes are necessary to corroborate our results and assess how well the catheter is visualised within the pleural effusion.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Funding</span><p id="par0185" class="elsevierStylePara elsevierViewall">This study has been funded, in part, by research grants from the <span class="elsevierStyleGrantSponsor" id="gs0005">Sociedad Castellano Leonesa y Cántabra de Neumología (SOCALPAR 2016)</span>. Lead researcher: Miguel Iglesias Heras and the SEPAR 2016 INTEGRATED RESEARCH PROGRAMME on INTERVENTIONAL PULMONOLOGY. Lead researcher: Miguel Iglesias Heras. The study has been carried out without any commercial interests.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Author contributions</span><p id="par0190" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0015"><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">1</span><p id="par0195" class="elsevierStylePara elsevierViewall">Research coordinators: MIH.</p></li><li class="elsevierStyleListItem" id="lsti0040"><span class="elsevierStyleLabel">2</span><p id="par0200" class="elsevierStylePara elsevierViewall">Study concept: MIH.</p></li><li class="elsevierStyleListItem" id="lsti0045"><span class="elsevierStyleLabel">3</span><p id="par0205" class="elsevierStylePara elsevierViewall">Study design: MIH and RC.</p></li><li class="elsevierStyleListItem" id="lsti0050"><span class="elsevierStyleLabel">4</span><p id="par0210" class="elsevierStylePara elsevierViewall">Data collection: MIH, EJM, JC, JMFG-H and EYZ</p></li><li class="elsevierStyleListItem" id="lsti0055"><span class="elsevierStyleLabel">5</span><p id="par0215" class="elsevierStylePara elsevierViewall">Data analysis and interpretation: MIH.</p></li><li class="elsevierStyleListItem" id="lsti0060"><span class="elsevierStyleLabel">6</span><p id="par0220" class="elsevierStylePara elsevierViewall">Data processing: MIH.</p></li><li class="elsevierStyleListItem" id="lsti0065"><span class="elsevierStyleLabel">7</span><p id="par0225" class="elsevierStylePara elsevierViewall">Literature search: MIH.</p></li><li class="elsevierStyleListItem" id="lsti0070"><span class="elsevierStyleLabel">8</span><p id="par0230" class="elsevierStylePara elsevierViewall">Drafting of article: MIH.</p></li><li class="elsevierStyleListItem" id="lsti0075"><span class="elsevierStyleLabel">9</span><p id="par0235" class="elsevierStylePara elsevierViewall">Critical review of the manuscript with intellectually relevant contributions: JOdeSB and RC.</p></li><li class="elsevierStyleListItem" id="lsti0080"><span class="elsevierStyleLabel">10</span><p id="par0240" class="elsevierStylePara elsevierViewall">Approval of the final version: MIH, EJm, JOdeSB, JC and RC.</p></li></ul></p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Conflicts of interest</span><p id="par0245" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest that could inappropriately influence the work.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:13 [ 0 => array:3 [ "identificador" => "xres2132309" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Patients and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1810807" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres2132308" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Pacientes y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1810806" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Patients and methods" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Funding" ] 9 => array:2 [ "identificador" => "sec0030" "titulo" => "Author contributions" ] 10 => array:2 [ "identificador" => "sec0035" "titulo" => "Conflicts of interest" ] 11 => array:2 [ "identificador" => "xack739970" "titulo" => "Acknowledgments" ] 12 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2022-12-24" "fechaAceptado" => "2023-04-20" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1810807" "palabras" => array:5 [ 0 => "Malignant pleural effusion" 1 => "Ultrasonography" 2 => "Indwelling pleural catheter" 3 => "Removal" 4 => "Pleurodesis" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1810806" "palabras" => array:5 [ 0 => "Derrame pleural maligno" 1 => "Ecografía" 2 => "Catéter pleural tunelizado" 3 => "Retirada" 4 => "Pleurodesis" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">There are no defined criteria for deciding to remove a non-functioning indwelling pleural catheter (IPC) when lung re-expansion on chest X-ray is incomplete. Chest computed tomography (chest CT) is usually used. The objective of this work is to validate the usefulness of chest ultrasound performed by a pulmonologist and by a radiologist compared to chest CT.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Patients and methods</span><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Prospective, descriptive, multidisciplinary and multicenter study including patients with malignant pleural effusion and non-functioning IPC without lung reexpansion. Decisions made on the basis of chest ultrasound performed by a pulmonologist, and performed by a radiologist, were compared with chest CT as the gold standard.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">18 patients were analyzed, all of them underwent ultrasound by a pulmonologist and chest CT and in 11 of them also ultrasound by a radiologist. The ultrasound performed by the pulmonologist presents a sensitivity of 60%, specificity of 100%, PPV 100% and NPV 66% in the decision of the correct removal of the IPC. The concordance of both ultrasounds (pulmonologist and radiologist) was 100%, with a kappa index of 1. The 4 discordant cases were those in which the IPC was not located on the ultrasound.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Thoracic ultrasound performed by an expert pulmonologist is a valid and simple tool to determine spontaneous pleurodesis and remove a non-functioning IPC, which would make it possible to avoid chest CT in those cases in which lung reexpansion is observed with ultrasonography.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Patients and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducción</span><p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">No existen criterios definidos para decidir la retirada de un CPT no funcionante cuando la reexpansión pulmonar en la radiografía de tórax es incompleta. En muchas ocasiones se utiliza la tomografía computarizada de tórax (TC de tórax). El objetivo de este trabajo es validar la utilidad de la ecografía torácica realizada por un neumólogo y por un radiólogo en relación con la TC de tórax.</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Pacientes y métodos</span><p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">Estudio prospectivo, descriptivo, multidisciplinar y multicéntrico de pacientes con derrame pleural maligno y CPT no funcionante sin reexpansión pulmonar. Se compararon las decisiones tomadas en base a la ecografía torácica realizada por un neumólogo, realizada por un radiólogo con la TC de tórax como <span class="elsevierStyleItalic">técnica de referencia.</span></p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">Se analizan 18 pacientes, a todos ellos se realiza ecografía por neumólogo y TC de tórax y en 11 de ellos también ecografía por radiólogo. La ecografía realizada por el neumólogo presenta una sensibilidad del 60%, especificidad del 100%, VPP 100% y VPN 66% en la decisión de la retirada correcta del CPT. La concordancia de ambas ecografías (neumólogo y radiólogo) fue del 100%, con un índice kappa de 1. Los 4 casos discordantes fueron aquellos en los que no se localizó el CPT en la ecografía.</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">La ecografía torácica realizada por un neumólogo experto es una herramienta válida y sencilla para determinar pleurodesis espontánea y retirar un CPT no funcionante, lo que permitiría evitar una TC de tórax en aquellos casos en los que se objetive reexpansión pulmonar con la ultrasonografía.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Pacientes y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "multimedia" => array:9 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1311 "Ancho" => 2341 "Tamanyo" => 185868 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Protocol for removal. Decision tree for the removal of non-draining IPCs based on lung re-expansion on chest radiograph, chest CT and ultrasound. It defines spontaneous pleurodesis and the indication for IPC removal. IPC: indwelling pleural catheter; CU: chest ultrasound.</p>" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 638 "Ancho" => 1340 "Tamanyo" => 90160 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Chest radiograph with lung re-expansion. A) PA chest radiograph with significant right pleural effusion prior to IPC placement. B) PA chest X-ray of the same patient, with lung re-expansion >80% after placement of the © (C).</p>" ] ] 2 => array:8 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1019 "Ancho" => 1675 "Tamanyo" => 134245 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Chest ultrasound with pleural effusion and visible catheter. Chest ultrasound showing the anechoic pleural effusion, with no lung re-expansion, the liver, the diaphragm and the indwelling catheter inside the effusion.</p>" ] ] 3 => array:8 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 1388 "Ancho" => 2083 "Tamanyo" => 159102 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0020" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Patient selection flowchart. We assessed 41 non-draining IPCs. Twenty-two are removed due to lung re-expansion, and another by the patient's decision. Eighteen patients entered the study, all of whom underwent ultrasound by a pulmonologist and chest CT, and 11 underwent ultrasound by a radiologist. IPC: indwelling pleural catheter.</p>" ] ] 4 => array:8 [ "identificador" => "fig0025" "etiqueta" => "Figure 5" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr5.jpeg" "Alto" => 2259 "Ancho" => 2175 "Tamanyo" => 327701 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0025" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Images of non-re-expanded lung with the drain placed outside the effusion. A) PA chest radiograph with significant left pleural effusion, with IPC. B) Lateral chest radiograph of the same patient with two posterior loculations. C) Chest CT showing a loculated pleural effusion with IPC placed outside.</p>" ] ] 5 => array:8 [ "identificador" => "fig0030" "etiqueta" => "Figure 6" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr6.jpeg" "Alto" => 1207 "Ancho" => 2341 "Tamanyo" => 149544 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0030" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Removal decision diagram. Division of patients according to the decision to remove the IPC or not. Based on chest CT data, the catheter was removed in 14 cases and not in four cases. Of the cases where it was decided to remove the IPC, the decision was consistent with the ultrasound results in 10 cases. Chest ultrasound also supported the four decisions to not remove. IPC: indwelling pleural catheter; CU: chest ultrasound.</p>" ] ] 6 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0035" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">IPC: indwelling pleural catheter.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Average age (years) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">64.9 \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Sex (female) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11 (61.1%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Primary tumour \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Lung \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Gynaecological \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Breast \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Colon \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Haematological \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Laryngeal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Renal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Unknown \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Positive pleural fluid cytology \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 (44.4%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Mean time with IPC (days) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">67.8 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Placement side (left) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11 (61.1%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">IPC complications \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3515212.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Demographic characteristics of the study population (<span class="elsevierStyleItalic">n</span> = 18).</p>" ] ] 7 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0040" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">CU: chest ultrasound; CT: computed tomography.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col"><span class="elsevierStyleItalic">n</span> = 18 \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">CU by pulmonologist</th></tr><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Removed \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Not removed \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Chest CT \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Removed \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Not removed \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3515210.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Chest ultrasound vs CT.</p>" ] ] 8 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0045" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">CU: chest ultrasound.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col"><span class="elsevierStyleItalic">n</span> = 11 \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">CU by pulmonologist</th></tr><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Removed \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Not removed \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">CU by radiologist \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Removed \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Not removed \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3515211.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Chest ultrasound by pulmonologist vs. radiologist.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:19 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Interventions for the management of malignant pleural effusions: A network meta-analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "A.O.J. Clive" 1 => "H.E. Jones" 2 => "R. Bhatnagar" 3 => "N.J. Perston" 4 => "N. Maskell" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/14651858.CD010529.pub2" "Revista" => array:2 [ "tituloSerie" => "Cochrane Database Syst Rev" "fecha" => "2016" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Management of a malignant pleural effusion: British Thoracic Society Pleural Disease Guideline 2010" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "M.E. Roberts" 1 => "E. Neville" 2 => "R.G. Berrisford" 3 => "G. Antunes" 4 => "N.J. Ali" 5 => "BTS Pleural Disease Guideline Group" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/thx.2010.136994" "Revista" => array:7 [ "tituloSerie" => "Thorax" "fecha" => "2010" "volumen" => "65" "numero" => "Suppl. 2" "paginaInicial" => "ii32" "paginaFinal" => "ii40" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20696691" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Management of malignant pleural effusions" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "V.B. Antony" 1 => "R. Loddenkemper" 2 => "P. Astoul" 3 => "C. Boutin" 4 => "P. Glodstraw" 5 => "J. Hott" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1183/09031936.01.00225601" "Revista" => array:6 [ "tituloSerie" => "Eur Respir J" "fecha" => "2001" "volumen" => "18" "paginaInicial" => "402" "paginaFinal" => "419" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11529302" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Efficacy and safety of tunneled pleural catheters in adults with malignant pleural effusions: A systematic review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "M.E. Van Meter" 1 => "K.Y. McKee" 2 => "R.J. Kohlwes" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s11606-010-1472-0" "Revista" => array:6 [ "tituloSerie" => "J Gen Intern Med" "fecha" => "2011" "volumen" => "26" "paginaInicial" => "70" "paginaFinal" => "76" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20697963" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The impact of tunneled pleural catheters on the quality of life of patients with malignant pleural effusions" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "N.F. Sabur" 1 => "A. Chee" 2 => "D.R. Stather" 3 => "P. Maceachern" 4 => "K. Amjadi" 5 => "C.A. Hergott" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1159/000342343" "Revista" => array:6 [ "tituloSerie" => "Respiration" "fecha" => "2013" "volumen" => "85" "paginaInicial" => "36" "paginaFinal" => "42" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23154202" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Quality-of-life assessment in malignant pleural effusion treated with indwelling pleural catheter: A prospective study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.J. Lorenzo" 1 => "M. Modesto" 2 => "J. Pérez" 3 => "E. Bollo" 4 => "R. Cordovilla" 5 => "M. Muñoz" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1177/0269216314521851" "Revista" => array:5 [ "tituloSerie" => "Palliat Med" "fecha" => "2014" "volumen" => "28" "paginaInicial" => "326" "paginaFinal" => "334" ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "ERS/EACTS statement on the management of malignant pleural effusions" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A.C. Bibby" 1 => "P. Dorn" 2 => "I. Psallidas" 3 => "J.M. Porcel" 4 => "J. Janssen" 5 => "M. Froudarakis" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1183/13993003.00349-2018" "Revista" => array:3 [ "tituloSerie" => "Eur Respir J" "fecha" => "2018" "volumen" => "52" ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A randomized controlled trial comparing indwelling pleural catheters with talc pleurodesis (NVALT-14)" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R.C. Boshuizen" 1 => "V. Vd Noort" 2 => "J.A. Burgers" 3 => "G.J.M. Herder" 4 => "S.M.S. Hashemi" 5 => "T.J.N. Hiltermann" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.lungcan.2017.01.019" "Revista" => array:6 [ "tituloSerie" => "Lung Cancer" "fecha" => "2017" "volumen" => "108" "paginaInicial" => "9" "paginaFinal" => "14" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28625655" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0045" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Indwelling pleural catheters. A clinical option in trapped Lung" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "L. Bertolaccini" 1 => "A. Viti" 2 => "S. Paiano" 3 => "C. Pomari" 4 => "L.R. Assante" 5 => "A. Terzi" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.thorsurg.2016.08.008" "Revista" => array:6 [ "tituloSerie" => "Thorac Surg Clin" "fecha" => "2017" "volumen" => "27" "paginaInicial" => "47" "paginaFinal" => "55" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27865327" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0050" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Interventional pulmonologist perspective: treatment of malignant pleural effusion" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "A.J. Sweatt" 1 => "A. Sung" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s11864-014-0312-6" "Revista" => array:6 [ "tituloSerie" => "Curr Treat Options Oncol" "fecha" => "2014" "volumen" => "15" "paginaInicial" => "625" "paginaFinal" => "643" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25240411" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0055" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Management of malignant pleural effusions. An Official ATS/STS/STR Clinical Practice Guideline" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "D.J. Feller-Kopman" 1 => "C.B. Reddy" 2 => "M.M. DeCamp" 3 => "R.L. Diekemper" 4 => "M.K. Gould" 5 => "T. Henry" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1164/rccm.201807-1415ST" "Revista" => array:6 [ "tituloSerie" => "Am J Respir Crit Care Med" "fecha" => "2018" "volumen" => "198" "paginaInicial" => "839" "paginaFinal" => "849" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30272503" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0060" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Outpatient talc administration by indwelling pleural catheter for malignant effusion" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R. Bhatnagar" 1 => "E.K. Keenan" 2 => "A.J. Morley" 3 => "B.C. Kahan" 4 => "A.E. Stanton" 5 => "M. Haris" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJMoa1716883" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "2018" "volumen" => "378" "paginaInicial" => "1313" "paginaFinal" => "1322" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29617585" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0065" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Single-center experience with 250 tunnelled pleural catheter insertions for malignant pleural effusion" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "A. Tremblay" 1 => "G. Michaud" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1378/chest.129.2.362" "Revista" => array:6 [ "tituloSerie" => "Chest" "fecha" => "2006" "volumen" => "129" "paginaInicial" => "362" "paginaFinal" => "368" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16478853" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0070" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Effect of an indwelling pleural catheter vs chest tube and talc pleurodesis for relieving dyspnea in patients with malignant pleural effusion: the TIME2 randomized controlled trial" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "H.E. Davies" 1 => "E.K. Mishra" 2 => "B.C. Kahan" 3 => "J.M. Wrightson" 4 => "A.E. Stanton" 5 => "A. Guhan" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/jama.2012.5535" "Revista" => array:6 [ "tituloSerie" => "JAMA" "fecha" => "2012" "volumen" => "307" "paginaInicial" => "2383" "paginaFinal" => "2389" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22610520" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0075" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Management of malignant pleural effusions using the Pleur(x) catheter" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "W.H. Warren" 1 => "R. Kalimi" 2 => "L.M. Khodadadian" 3 => "A.W. Kim" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.athoracsur.2007.11.039" "Revista" => array:7 [ "tituloSerie" => "Ann Thorac Surg" "fecha" => "2008" "volumen" => "85" "paginaInicial" => "1049" "paginaFinal" => "1055" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18291195" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S1056872717305470" "estado" => "S300" "issn" => "10568727" ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0080" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Effect of chemotherapy on removal of indwelling pleural catheters in breast cancer patients with malignant pleural effusions" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "M.A. Mitchell" 1 => "A. Burkett" 2 => "P. Li" 3 => "T. Zhang" 4 => "K. Amjadi" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1159/000491097" "Revista" => array:6 [ "tituloSerie" => "Respiration" "fecha" => "2018" "volumen" => "96" "paginaInicial" => "552" "paginaFinal" => "559" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30205402" "web" => "Medline" ] ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0085" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Malignant pleural effusion: From diagnostics to therapeutics" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "R. Asciak" 1 => "N. Rahman" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ccm.2017.11.004" "Revista" => array:6 [ "tituloSerie" => "Clin Chest Med" "fecha" => "2018" "volumen" => "39" "paginaInicial" => "181" "paginaFinal" => "193" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29433714" "web" => "Medline" ] ] ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0090" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Talc pleurodesis through indwelling pleural catheters for malignant pleural effusions: Retrospective case series of a novel clinical pathway" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "L. Ahmed" 1 => "H. Ip" 2 => "D. Rao" 3 => "N. Patel" 4 => "F. Noorzad" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1378/chest.14-0394" "Revista" => array:6 [ "tituloSerie" => "Chest" "fecha" => "2014" "volumen" => "146" "paginaInicial" => "e190" "paginaFinal" => "194" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25451360" "web" => "Medline" ] ] ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0095" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Thoracic ultrasound as a predictor of pleurodesis success at the time of indwelling pleural catheter removal" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "U. Chaddha" 1 => "A. Agrawal" 2 => "S.V. Bhavani" 3 => "K. Sivertsen" 4 => "D.J. Donington" 5 => "M.K. Ferguson" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/resp.13937" "Revista" => array:6 [ "tituloSerie" => "Respirology" "fecha" => "2021" "volumen" => "26" "paginaInicial" => "249" "paginaFinal" => "254" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32929838" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:4 [ "identificador" => "xack739970" "titulo" => "Acknowledgments" "texto" => "<p id="par0250" class="elsevierStylePara elsevierViewall">The authors would like to thank the nursing staff of the Bronchoscopy and Interventional Pulmonology Unit of the University Hospital of Salamanca and everyone who has collaborated in any way. They also recognise SOCALPAR and the SEPAR Integrated Research Programme on Interventional Pulmonology for its funding.</p>" "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/21735107/00000066000000S1/v1_202404190701/S2173510724000351/v1_202404190701/en/main.assets" "Apartado" => array:4 [ "identificador" => "66551" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Original articles" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735107/00000066000000S1/v1_202404190701/S2173510724000351/v1_202404190701/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173510724000351?idApp=UINPBA00004N" ]
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