Management of Malignant Pleural Effusions An Official ATS/STS/STR Clinical Practice Guideline
Top Cited Papers
- 30 September 2018
- journal article
- research article
- Published by American Thoracic Society in American Journal of Respiratory and Critical Care Medicine
- Vol. 198 (7), 839-849
- https://doi.org/10.1164/rccm.201807-1415ST
Abstract
Background: This Guideline, a collaborative effort from the American Thoracic Society, Society of Thoracic Surgeons, and Society of Thoracic Radiology, aims to provide evidence-based recommendations to guide contemporary management of patients with a malignant pleural effusion (MPE). Methods: A multidisciplinary panel developed seven questions using the PICO (Population, Intervention, Comparator, and Outcomes) format. The GRADE (Grading of Recommendations, Assessment, Development and Evaluation) approach and the Evidence to Decision framework was applied to each question. Recommendations were formulated, discussed, and approved by the entire panel. Results: The panel made weak recommendations in favor of: 1) using ultrasound to guide pleural interventions; 2) not performing pleural interventions in asymptomatic patients with MPE; 3) using either an indwelling pleural catheter (IPC) or chemical pleurodesis in symptomatic patients with MPE and suspected expandable lung; 4) performing large-volume thoracentesis to assess symptomatic response and lung expansion; 5) using either talc poudrage or talc slurry for chemical pleurodesis; 6) using IPC instead of chemical pleurodesis in patients with nonexpandable lung or failed pleurodesis; and 7) treating IPC-associated infections with antibiotics and not removing the catheter. Conclusions: These recommendations, based on the best available evidence, can guide management of patients with MPE and improve patient outcomes.Keywords
This publication has 72 references indexed in Scilit:
- Physician‐performed ultrasound can accurately screen for a vulnerable intercostal artery prior to chest drainage proceduresRespirology, 2013
- GRADE guidelines: 7. Rating the quality of evidence—inconsistencyJournal of Clinical Epidemiology, 2011
- Management of a malignant pleural effusion: British Thoracic Society pleural disease guideline 2010Thorax, 2010
- Treatment of Infection Associated With Tunneled Pleural CathetersJournal of Bronchology & Interventional Pulmonology, 2010
- Therapeutic thoracentesis: the role of ultrasound and pleural manometryCurrent Opinion in Pulmonary Medicine, 2007
- Natural History of Asymptomatic Pleural Effusions in Lung Cancer PatientsJournal of Bronchology, 2007
- Talc mediates angiostasis in malignant pleural effusions via endostatin inductionEuropean Respiratory Journal, 2007
- Talc poudrage versus talc slurry in the treatment of malignant pleural effusion.European Journal of Cardio-Thoracic Surgery, 2006
- The evidence on the effectiveness of management for malignant pleural effusion: a systematic reviewEuropean Journal of Cardio-Thoracic Surgery, 2006
- Mechanism of relief of dyspnea after thoracocentesis in patients with large pleural effusionsAmerican Journal Of Medicine, 1983