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• W4303985544 abstract "SESSION TITLE: Analyzing What We Do in the ICUSESSION TYPE: Rapid Fire Original InvPRESENTED ON: 10/17/2022 12:15 pm - 1:15 pmPURPOSE: Benign pleural effusions (BPE) are associated with higher readmission rates and mortality in patients with decompensated congestive heart failure (dCHF); although most subjects respond to medical treatment and/or initial drainage, some can be refractory to medical therapy and require repeated drainage procedures. In these patients, a long-term strategy often includes the use of tunneled pleural catheter (TPC), pleurodesis or a combination; little is known about what factors predict refractory BPE in these patients. We describe the main characteristics of patients refractory to initial pleural drainage procedures combined with medical management, including those requiring TPC placementMETHODS: We performed a retrospective review of patients with dCHF and associated BPE requiring any type of drainage (thoracentesis, tube thoracostomy or TPC) with a pleural fluid NT-proBNP > 1400 ng/mL, admitted at Beth Israel Deaconess Medical Center between 2013 and 2022. Patients with malignant pleural effusion, pleural infection, thoracic surgery within 1 month, and no follow-up after last drainage procedure were excluded. Patients were divided into two groups; group 1 (patients with clinical/radiographic improvement after one drainage procedure) and group 2 (patients requiring >1 drainage procedure, TPC, and/or pleurodesis). Baseline demographics, comorbidities, medications, pleural fluid analysis, echocardiographic measures, and radiographic characteristics were compared between groups.RESULTS: Seventy-one patients were included. The median age was 78.0 years [IQR 69.0-84.0], 44 [62.5%] were male, and a median BMI of 24.8 [IQR, 21.5-27.3]. BPE were transudative in 56 (78.9%) patients, pseudo-exudative in 11 (15.4%) patients and exudative in 4 (5.6%) patients. In group 1, 25 patients required 1 procedure; in group 2, 46 patients required 2 or more procedures and 31 required a long-term strategy (27 TPC and 4 TPC with pleurodesis). Baseline characteristics, comorbidities, medications, and pleural effusion characteristics were equivalent between groups. The subset of Group 2 patients who required a long-term strategy were more likely to have heart failure with preserved ejection fraction (HFpEF) (61.3% vs. 25.0%, p<0.01) and left ventricular diastolic dysfunction as assessed by E/A ratio (median= 2.2 vs 1.0, p=0.02), E/e’ ratio (median= 22.5 vs 15.5, p= 0.03), and transmitral peak E-wave velocity (median = 1.25 vs 1.0, p= 0.04).CONCLUSIONS: When compared to patients successfully managed via medical management and initial drainage, patients requiring long-term pleural strategies had more frequently HFpEF and left ventricular diastolic dysfunction.CLINICAL IMPLICATIONS: Patients with dCHF and refractory pleural effusions, especially those with signs of diastolic dysfunction, may require additional definitive pleural interventions to prevent recurrence.DISCLOSURES: No relevant relationships by Lauren BurkeNo relevant relationships by Juan Camilo Cedeno SernaNo relevant relationships by Anil MaggeConsultant relationship with Boston Scientific Please note: $1001 - $5000 by Adnan Majid, value=Consulting feeConsultant relationship with olympus Please note: $5001 - $20000 by Adnan Majid, value=Consulting feeConsultant relationship with pinacle biologics Please note: $1001 - $5000 by Adnan Majid, value=Consulting feeNo relevant relationships by Mihir ParikhNo relevant relationships by Pablo QuinteroNo relevant relationships by Kai SwensonNo relevant relationships by Juan Pablo UribeNo relevant relationships by Chenchen Zhang SESSION TITLE: Analyzing What We Do in the ICU SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/17/2022 12:15 pm - 1:15 pm PURPOSE: Benign pleural effusions (BPE) are associated with higher readmission rates and mortality in patients with decompensated congestive heart failure (dCHF); although most subjects respond to medical treatment and/or initial drainage, some can be refractory to medical therapy and require repeated drainage procedures. In these patients, a long-term strategy often includes the use of tunneled pleural catheter (TPC), pleurodesis or a combination; little is known about what factors predict refractory BPE in these patients. We describe the main characteristics of patients refractory to initial pleural drainage procedures combined with medical management, including those requiring TPC placement METHODS: We performed a retrospective review of patients with dCHF and associated BPE requiring any type of drainage (thoracentesis, tube thoracostomy or TPC) with a pleural fluid NT-proBNP > 1400 ng/mL, admitted at Beth Israel Deaconess Medical Center between 2013 and 2022. Patients with malignant pleural effusion, pleural infection, thoracic surgery within 1 month, and no follow-up after last drainage procedure were excluded. Patients were divided into two groups; group 1 (patients with clinical/radiographic improvement after one drainage procedure) and group 2 (patients requiring >1 drainage procedure, TPC, and/or pleurodesis). Baseline demographics, comorbidities, medications, pleural fluid analysis, echocardiographic measures, and radiographic characteristics were compared between groups. RESULTS: Seventy-one patients were included. The median age was 78.0 years [IQR 69.0-84.0], 44 [62.5%] were male, and a median BMI of 24.8 [IQR, 21.5-27.3]. BPE were transudative in 56 (78.9%) patients, pseudo-exudative in 11 (15.4%) patients and exudative in 4 (5.6%) patients. In group 1, 25 patients required 1 procedure; in group 2, 46 patients required 2 or more procedures and 31 required a long-term strategy (27 TPC and 4 TPC with pleurodesis). Baseline characteristics, comorbidities, medications, and pleural effusion characteristics were equivalent between groups. The subset of Group 2 patients who required a long-term strategy were more likely to have heart failure with preserved ejection fraction (HFpEF) (61.3% vs. 25.0%, p<0.01) and left ventricular diastolic dysfunction as assessed by E/A ratio (median= 2.2 vs 1.0, p=0.02), E/e’ ratio (median= 22.5 vs 15.5, p= 0.03), and transmitral peak E-wave velocity (median = 1.25 vs 1.0, p= 0.04). CONCLUSIONS: When compared to patients successfully managed via medical management and initial drainage, patients requiring long-term pleural strategies had more frequently HFpEF and left ventricular diastolic dysfunction. CLINICAL IMPLICATIONS: Patients with dCHF and refractory pleural effusions, especially those with signs of diastolic dysfunction, may require additional definitive pleural interventions to prevent recurrence. DISCLOSURES: No relevant relationships by Lauren Burke No relevant relationships by Juan Camilo Cedeno Serna No relevant relationships by Anil Magge Consultant relationship with Boston Scientific Please note: $1001 - $5000 by Adnan Majid, value=Consulting fee Consultant relationship with olympus Please note: $5001 - $20000 by Adnan Majid, value=Consulting fee Consultant relationship with pinacle biologics Please note: $1001 - $5000 by Adnan Majid, value=Consulting fee No relevant relationships by Mihir Parikh No relevant relationships by Pablo Quintero No relevant relationships by Kai Swenson No relevant relationships by Juan Pablo Uribe No relevant relationships by Chenchen Zhang" @default.
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• W4303985544 date "2022-10-01" @default.
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• W4303985544 title "CAN WE PREDICT WHO WILL DEVELOP RECURRENT PLEURAL EFFUSIONS IN PATIENTS WITH HEART FAILURE?" @default.
• W4303985544 doi "https://doi.org/10.1016/j.chest.2022.08.1195" @default.
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