Pulmonary Self-Study Resources-Feller-Kopman, Management of MPE, AJRCCM 2018

Pdf Summary

The official clinical practice guidelines for the management of malignant pleural effusions (MPE) were collaboratively developed by the American Thoracic Society (ATS), the Society of Thoracic Surgeons (STS), and the Society of Thoracic Radiology (STR). These guidelines aim to provide evidence-based recommendations to guide the contemporary management of patients with MPE.<br /><br />A multidisciplinary panel utilized the PICO (Population, Intervention, Comparator, Outcomes) format and the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach to develop and discuss seven key questions relevant to the management of MPE. The resulting recommendations fall into various categories:<br /><br />1. **Use of Ultrasound**: Ultrasound is suggested to guide pleural interventions to reduce complications such as pneumothorax.<br />2. **Asymptomatic Patients**: Therapeutic pleural interventions should be avoided in asymptomatic patients to prevent unnecessary risk.<br />3. **Therapeutic Thoracentesis**: It is recommended to perform large-volume thoracentesis to determine if a patient's symptoms are related to the effusion and to assess lung expansion.<br />4. **First-Line Interventions**: For symptomatic patients with likely expandable lungs, both indwelling pleural catheters (IPCs) and chemical pleurodesis are suggested as first-line definitive interventions for managing dyspnea.<br />5. **Talc Pleurodesis**: Either talc poudrage or talc slurry methods can be used, with no clear preference indicated.<br />6. **Nonexpandable Lung, Failed Pleurodesis, or Loculated Effusion**: IPCs are recommended over chemical pleurodesis for patients with nonexpandable lung, failed pleurodesis, or symptomatic loculated effusions.<br />7. **IPC-associated Infections**: Treating IPC-associated infections with antibiotics is recommended without removing the catheter unless the infection fails to improve.<br /><br />The guidelines emphasize patient-centered outcomes and recommend considering factors such as reduced hospital stays, treatment failures, and a patient’s quality of life and preferences in decision-making. Future research directions include investigating ultrasound’s expanded roles, the impact of asymptomatic MPEs, prediction methods for symptomatic responses and lung expansion, combining IPCs with chemical pleurodesis, and best treatments for IPC-related infections. <br /><br />These updated guidelines are crucial for clinicians managing MPE to enhance patient outcomes and offer definitive, minimally invasive interventions where possible.

Meta Tag

Asset Type PDF

Curriculum Category Pleural Disease

Curriculum Subcategory Diagnostic and therapeutic procedures

Keywords

malignant pleural effusions

clinical practice guidelines

American Thoracic Society

ultrasound-guided interventions

therapeutic thoracentesis

indwelling pleural catheters

chemical pleurodesis