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

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The clinical practice guideline on the management of malignant pleural effusions (MPE) was collaboratively developed by the American Thoracic Society, Society of Thoracic Surgeons, and Society of Thoracic Radiology and approved in 2018. It aims to guide evidence-based practices in treating MPE.<br /><br />The multidisciplinary panel addressed seven key questions using the PICO (Population, Intervention, Comparator, and Outcome) format and the GRADE approach to develop recommendations:<br />1. Use of ultrasound to guide pleural interventions is suggested.<br />2. Pleural interventions should not be performed in asymptomatic patients.<br />3. For symptomatic patients, large-volume thoracentesis is recommended to evaluate symptomatic response and lung expansion.<br />4. Either indwelling pleural catheters (IPC) or chemical pleurodesis can be used as first-line treatment for dyspnea in patients with expandably suspected lungs.<br />5. For symptomatic MPE patients undergoing talc pleurodesis, both talc poudrage and talc slurry are viable options.<br />6. IPC is recommended over pleurodesis for patients with nonexpandable lung, failed pleurodesis, or loculated effusion.<br />7. IPC-associated infections should be treated with antibiotics, reserving catheter removal for cases where infection does not improve.<br /><br />The recommendations aim to enhance patient outcomes by relieving symptoms and minimizing repeated procedures. They emphasize patient-centered approaches and consider factors like local expertise, availability of resources, and patient preferences.<br /><br />Key research priorities include better prediction methods for lung expansion and the effectiveness of interventions, increased understanding of IPC and pleurodesis use, and optimal management strategies for IPC-related infections. This document also underscores the necessity of updating guidelines with new evidence as the treatment landscape of MPE evolves.

Meta Tag

Asset Type PDF

Curriculum Category Pulmonary Disease in Critical Care

Keywords

malignant pleural effusions

clinical practice guideline

American Thoracic Society

pleural interventions

ultrasound guidance

indwelling pleural catheters

chemical pleurodesis

talc pleurodesis

patient outcomes

IPC-associated infections