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Management of Malignant Pleural Effusions

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Diagnosis ➤ In patients with known or suspected MPE, we suggest that ultrasound imaging be used to guide pleural interventions. (conditional recommendation, very low confidence in estimate of effects) ➤ In patients with known or suspected MPE who are asymptomatic, we suggest that therapeutic pleural interventions NOT be performed. (conditional recommendation, very low confidence in estimate of effects) ➤ In patients with symptomatic MPE, we suggest large-volume thoracentesis if it is uncertain whether the patient's symptoms are related to the effusion and/or if the lung is expandable (the latter if pleurodesis is contemplated) to assess lung expansion. (conditional recommendation, very low confidence in estimate of effects) ➤ In patients with MPE with known (or likely) suspected expandable lung and no prior definitive therapy, and whose symptoms are attributable to the effusion, we suggest that either IPCs or chemical pleurodesis be used as first-line definitive intervention for management of dyspnea. (conditional recommendation, low confidence in estimate of effects) ➤ In patients with symptomatic MPE and expandable lung undergoing talc pleurodesis, we suggest the use of either talc poudrage or talc slurry. (conditional recommendation, low confidence in estimate of effects) ➤ In patients with symptomatic MPE with nonexpandable lung, failed pleurodesis, or loculated effusion, we suggest the use of IPCs over chemical pleurodesis. (conditional recommendation, very low confidence in estimate of effects) ➤ In patients with IPC-associated infections, treating through the infection without catheter removal is usually adequate. We suggest catheter removal if the infection fails to improve. (conditional recommendation, very low confidence in estimate of effects)

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