BTS guidelines for the management of malignant pleural effusions

Antunes, George; Neville, E.; Duffy, John P.; Ali, Katijjahbe Mohd

doi:10.1136/thx.58.suppl_2.ii29

Cited by 261 publications

(42 citation statements)

References 55 publications

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“…In Japan, OK-432, a purified preparation derived from Streptococcus pyogenes, is primarily used as a sclerosing agent. In contrast, the worldwide standard therapy for controlling malignant pleural effusions is pleurodesis with talc, as talc has been reported to have a better success rate and a lower incidence of side effects than other agents (1,2).…”

Section: Introductionmentioning

confidence: 99%

Talc Pleurodesis for the Management of Malignant Pleural Effusions in Japan

et al. 2013

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Objective Malignant pleural effusions are commonly treated with tube drainage followed by chemical pleurodesis to maintain the patient's quality of life. While talc is now accepted to be a worldwide goldstandard sclerosing agent for treating malignant pleural effusion, it is not yet approved in Japan. Instead, many patients are administered OK-432 for pleurodesis, which carries the risk of complications such as highgrade fever, chest pain, anaphylactic shock, interstitial pneumonia and acute renal failure. To assess the efficacy and safety of talc as a sclerosing agent in the management of malignant pleural effusions in Japanese patients. Methods Pleurodesis was performed using 4 g of sterile talc with thoracoscopic talc poudrage or the administration of talc slurry via a chest tube in patients with malignant pleural effusions. Results A total of 57 patients were included. The success rate of pleurodesis assessed on chest radiography at 30, 90 and 180 days was 90.6%, 80.9% and 76.1%, respectively. Complications occurring after talc pleurodesis included fever in 10.5% of the patients and chest pain in 14.0% of the patients. No major complications were reported. Conclusion Talc pleurodesis is an effective and safe treatment for the management of malignant pleural effusion in Japanese patients.

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Section: Introductionmentioning

confidence: 99%

Talc Pleurodesis for the Management of Malignant Pleural Effusions in Japan

et al. 2013

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“…1,2 Advances in pleural palliation have led to the rather widespread adoption of the indwelling tunneled pleural catheter (IPC) as a tool for managing symptomatic, recurrent MPEs. Th is includes current British Th oracic Society guidelines, which off er a grade B recommendation for IPC placement as "eff ective in controlling recurrent and symptomatic malignant eff usions in select patients."…”

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confidence: 99%

The Use of Indwelling Tunneled Pleural Catheters for Recurrent Pleural Effusions in Patients With Hematologic Malignancies

Gilbert

Lee

Skalski

et al. 2015

CHEST

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“…Even with the use of modern immunostaining techniques, pleural fluid cytology has a diagnostic sensitivity of only 60% and a substantially lower sensitivity (ca 20%) in mesothelioma. 16 A second, separate pleural fluid aspirate increases diagnostic yield modestly (by ca 10%), but there is no further increase with a third sample. 17 About 40% of cases of pleural malignancy will therefore remain undiagnosed after cytological sampling.…”

Section: Cytological Analysismentioning

confidence: 99%

“…Although its presence (in non-mesothelioma) implies metastatic disease most commonly from lung, breast, bowel and lymphoma, 16 the advent of more focused oncological therapies means that accurate diagnosis often alters management or provides prognostic information.…”

Section: Malignant Pleural Effusionmentioning

confidence: 99%

“…Causative organism (% positive isolates)* Streptococcus milleri group (32) MRSA (28) Anaerobic organisms (16) Staphylococci (18) Streptococcus pneumoniae (13) Enterobacteriaceae (16) Staphylococci (11) Enterococci (13) Other streptococci (7) Anaerobic organisms (5) Enterobacteriae (7) Streptococcus milleri group (5) Haemophilus influenza (3) Pseudomonas spp (5) Proteus spp (3) Other streptococci (5) Other (8) Other (5) Suggested empirical antibiotic regimen 3rd generation cephalosporin or penicillin Broad-spectrum cover to provide activity with β-lactamase cover against resistant Gram-negatives, MRSA PLUS anaerobic cover (eg cefuroxime/ and anaerobes (eg vancomycin PLUS co-amoxiclav PLUS metronidazole) meropenem)…”

Section: Community Acquired Hospital Acquiredmentioning

confidence: 99%

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Investigation of the patient with pleural effusion

Rahman

Munavvar

2009

Clinical Medicine

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Pleural effusion is a common clinical problem and may present to a wide range of specialties. Accurate aetiological diagnosis is key to subsequent management, requiring a multidisciplinary approach and knowledge of the correct investigation pathway. This article will focus on appropriate staged investigations for the patient presenting with pleural effusion rather than on its causes or treatment. Clinical syndromesPleural effusion is often detected on plain chest radiography as an incidental finding and patients may be asymptomatic. Clinical symptoms are variable, depending on the size and aetiology of the effusion and rarely specific enough to suggest a diagnosis in the absence of further investigations. Large effusions are likely to be associated with dyspnoea, but this is often a late finding and oxygen saturations may not be severely lowered. Dyspnoea is the result of impaired mechanics and increased intrapleural pressure swings.The presence of chest pain implies involvement of the parietal pleura which is heavily innervated. Inflammation, infection and malignant involvement may produce pain, including shoulder tip symptoms associated with diaphragmatic involvement. Weight loss, anorexia and malaise may imply malignancy or infection (eg empyema). CausesPleural effusions are divided into transudative and exudative (Table 1). They are diagnosed according to pleural fluid biochemical characteristics (see below). However, transudates occur with structurally normal pleura, in which oncotic or hydrostatic pressure results in fluid leak. In contrast, exudates occur with damaged or altered pleura, resulting in loss of tissue fluid and protein causing fluid formation. 1 Differentiation of transudate from exudate is key to further management. Treatment for transudative effusion relies on treatment of the underlying disease, and uncommonly requires specific pleural intervention. In contrast, exudative effusion usually needs further investigation and often requires intervention. Initial diagnostic approachThe presence of bilateral, symmetrical effusions in the appropriate clinical context is highly suggestive of transudative effusion, and in general requires no further investigation. 2 However, it should be noted that about 50% of heart failure CME Respiratory medicine • pleural fluid protein/serum protein >0.5• pleural fluid LDH/serum LDH >0.6• pleural fluid LDH more than two-thirds of the upper limit of normal serum LDH * If pleural fluid protein is 25-35 g/l or serum protein level is abnormal, apply Light's criteria. LDH = lactate dehydrogenase; TB = tuberculosis.

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BTS guidelines for the management of malignant pleural effusions

Cited by 261 publications

References 55 publications

Talc Pleurodesis for the Management of Malignant Pleural Effusions in Japan

Talc Pleurodesis for the Management of Malignant Pleural Effusions in Japan

The Use of Indwelling Tunneled Pleural Catheters for Recurrent Pleural Effusions in Patients With Hematologic Malignancies

Investigation of the patient with pleural effusion

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