Self-Study Resources-Bibby, ERS EACTS statemen on magmt of MPE, ERS 2018

Pdf Summary

The management of malignant pleural effusions (MPE), as reviewed by a task force established by the European Respiratory Society (ERS) and the European Association for Cardio-Thoracic Surgery (EACTS), has evolved significantly in recent years due to high-quality randomized clinical trials. These advancements allow for more informed, evidence-based clinical practices.<br /><br />Key Management Strategies for MPE:<br /><br />1. **Symptomatic Management**:<br />   - **Talc Pleurodesis**: Talc pleurodesis, administered either via slurry or poudrage, has been proven effective in controlling symptoms. Talc poudrage may have a slight advantage over slurry in terms of fluid control, though both methods are widely used.<br />   - **Indwelling Pleural Catheters (IPCs)**: IPCs provide symptom relief by allowing regular fluid drainage. These reduce hospital stays but may be associated with higher adverse event rates.<br /><br />2. **Trapped Lung in MPE**:<br />   - **Indwelling Pleural Catheters**: Limited evidence suggests IPCs are beneficial for symptom management in trapped lung. More prospective trials are needed to confirm their efficacy.<br /><br />3. **Loculated MPE**:<br />   - **Intrapleural Fibrinolytic Agents**: These agents can enhance fluid drainage and improve radiological outcomes in loculated MPE, although they do not significantly impact symptoms or pleurodesis success.<br /><br />4. **Prognosis**:<br />   - **LENT Score**: This tool helps predict survival based on lactate dehydrogenase levels, Eastern Cooperative Oncology Group performance status, neutrophil-to-lymphocyte ratio, and tumor type, dividing patients into low, moderate, or high-risk categories.<br />   - **Mesothelioma Prognosis**: A decision tree by Brims provides a prognostic tool considering factors specific to mesothelioma.<br /><br />5. **Oncological Treatment Prior to MPE Management**:<br />   - No strong evidence currently supports primary use of oncological therapies over standard interventions. Observational studies suggest potential utility in specific cases, such as with small cell lung cancer and lymphoma.<br /><br />6. **Diagnosis**:<br />   - **Cytology vs. Histology**: Histologic diagnosis (biopsy) is considered the gold standard, particularly with mesothelioma due to its lower cytological diagnostic yield. Newer molecular profiling techniques, including liquid biopsies, show promise but are not yet widespread.<br /><br />The task force highlights that despite these advances, uncertainties remain, particularly regarding the best management for trapped lung and the role of fibrinolytics in loculated MPE. Future research is essential for further optimizing care.

Meta Tag

Asset Type PDF

Curriculum Category Pulmonary Disease in Critical Care

Keywords

malignant pleural effusions

talc pleurodesis

indwelling pleural catheters

trapped lung

loculated MPE

intrapleural fibrinolytic agents

LENT score

mesothelioma prognosis

oncological treatment

diagnosis