Management of malignant pleural effusion in Italian clinical practice: a nationwide survey

Abstract

Background Pleural disease (PD), particularly malignant pleural effusion (MPE), is a common cause of hospital admission and its prevalence is rising worldwide. Recent advances in diagnostic and therapeutic options, such as Indwelling Pleural Catheters (IPCs), have simplified PD treatment, allowing an effective outpatients management. Therefore, dedicated pleural services can improve PD care, guaranteeing specialized management and optimizing time and cost. We aimed to provide an overview on MPE management in Italy, mainly focused on distribution and characteristics of pleural services and IPCs use. Methods A nationwide survey, endorsed by the Italian Thoracic Society, was distributed by email to members of selected subgroups in 2021. Results Ninety (23%) members replied, most of whom being pulmonologists (91%). MPE resulted the most common cause of pleural effusion and was managed with heterogenous approaches, including talc pleurodesis via slurry (43%), talc poudrage (31%), repeated thoracentesis (22%) and IPCs insertion (2%). The setting of IPC insertion was inpatient care in 48% of cases, with a predominance of draining frequency every other day. IPC management mainly relied on caregivers (42%). The presence of a pleural service was reported by 37% of respondents. Conclusions The present study provides an extensive overview of MPE management in Italy, showing a highly heterogeneous approach, a scarce prevalence of out-patient pleural services, and a still limited adoption of IPCs, mainly due to lack of dedicated community care systems. This survey emphasizes the need of promoting a higher spreading of pleural services and an innovative healthcare delivery with more favourable cost-benefit ratio.

Ultrasound-Assisted and Ultrasound-Guided Thoracentesis: An Educational Review

“…Knowing approximately the amount of fluid volume and the probable nature of the effusion (transudate or exudates) allows the physician to make an informed decision on benefits and risks of the pleural procedures [ 13 , 30 ].…”

“…If the pleural effusion is large and complex, it will be necessary to place a drain for therapeutic purposes and/or evaluating video-assisted thoracoscopic surgery (VATS) [ 30 ]. Moreover, the operator should evaluate the chest wall and the intercostal space [ 23 ] ( Figure 5 ).…”