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)
