https://www.ncbi.nlm.nih.gov/pubmed/30272503
Guideline
Reference: Feller-Kkopman DJ, Reddy CB, Decamp MM, et al. Management of Malignant Pleural Effusions. An Official ATS/STS/STR Clinical Practice Guideline. Am J Respir Crit Care Med. 2018;198(7):839-849.
Summary:
The management of MPE is a common clinical scenario facing physicians. These guidelines summarize recommendations for the management of MPEs and include recommendations for the management of indwelling pleural catheter (IPC) related infections. These guidelines recommend:
- Ultrasound to guide pleural interventions
- Not to perform interventions on patients with asymptomatic known or suspected MPE
- Large volume thoracentesis in patients with a symptomatic MPE in order to determine whether or not the symptoms are related to the effusion and to determine whether the lung is expandable
- IPC placement or chemical pleurodesis as the first-line definitive management of dyspnea in patients with symptomatic MPE
- Either talc poudrage or talc slurry for a talc pleurodesis procedure
- IPC placement over chemical pleurodesis in patients with symptomatic MPE and non-expandable lung, failed pleurodesis or loculated pleural effusion
- Treating through an infection without catheter removal in patients with IPC associated infection, unless the infection fails to improve with these measures
ERS/EACTS statement on the management of malignant pleural effusions
https://www.ncbi.nlm.nih.gov/pubmed/30054348
Guideline
Reference: Bibby AC, Dorn P, Psallidas I, et al. ERS/EACTS statement on the management of malignant pleural effusions. Eur Respir J. 2018;52(1)
Summary: These guidelines provide recommendations for the management of MPE. These guidelines evaluate: the optimal management of symptomatic MPE, management of trapped lung and loculated MPE, prognostic factors in patients with MPE, role of oncologic therapies prior to intervention for MPE and the need for histologic diagnosis in MPE.
Management of a malignant pleural effusion: British Thoracic Society Pleural Disease Guideline 2010
https://pubmed.ncbi.nlm.nih.gov/20696691/
Landmark
Reference: Roberts ME, Neville E, Berrisford RG, Antunes G, Ali NJ. Management of a malignant pleural effusion: British Thoracic Society Pleural Disease Guideline 2010. Thorax. 2010;65 Suppl 2:ii32-40.
Summary: Malignant pleural effusions (MPE) can occur as a consequence of a variety of malignancies and are usually symptomatic requiring intervention. These guidelines summarize recommendations for the management of MPEs. These guidelines include information regarding management options for patients with MPEs with and without trapped lung, specifics for pleurodesis procedures, the role of thoracoscopy in the management of MPE as well as pleural catheters in this patient population.
Breathlessness predicts survival in patients with malignant pleural effusions: meta-analysis of individual patient data from five randomized controlled trials
https://pubmed.ncbi.nlm.nih.gov/33667489/
Review
Reference: Mishra EK, Muruganandan S, Clark A, et al. Breathlessness predicts survival in patients with malignant pleural effusions: meta-analysis of individual patient data from five randomized controlled trials. Chest. 2021;160(1):351-357.
Summary: This is a meta-analysis evaluating if breathlessness is associated with survival in patients with malignant pleural effusions. Visual analog scale (VAS) scores for dyspnea from five randomized controlled trials of patients undergoing interventions for malignant pleural effusions were evaluated. The patients were followed until death or trial end. The meta-analysis showed that baseline VAS scores for dyspnea were significantly associated with worse survival.
