Management of Malignant Pleural Effusions Clinical Practice Guidelines (2019)

American Thoracic Society, Society of Thoracic Surgeons, and Society of Thoracic Radiology

This is a quick summary of the guidelines without analysis or commentary. For more information, go directly to the guidelines by clicking the link in the reference.

March 01, 2019

The guidelines on the management of malignant pleural effusions were released on October 1, 2018, by the ATS/STS/STR.[1,2]

Use ultrasound to guide pleural interventions in known or suspected cases of malignant pleural effusion.

Therapeutic pleural interventions should not be used in asymptomatic patients with malignant pleural effusion.

Use either an indwelling pleural catheter or chemical pleurodesis to manage dyspnea in symptomatic patients with malignant pleural effusion and known or suspected expandable lung.

Perform large-volume thoracentesis to assess lung expansion in cases where it is unclear if symptoms are associated with effusion and/or to see if the lung is expandable.

Use either talc poudrage or talc slurry for patients undergoing talc pleurodesis.

Use an indwelling pleural catheter instead of chemical pleurodesis in patients with nonexpandable lung, failed pleurodesis, or loculated effusion.

Use antibiotics to treat infections associated with the indwelling pleural catheter with the catheter in place. Only remove the catheter if the infection persists.

For more Clinical Practice Guidelines, please go to Guidelines.

For more information, go to Pleural Effusion.

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