Management of pleural effusions

The management of pleural effusion usually involves the drainage of the effusion, identification, and treatment of the underlying cause (s). Studies have shown that the initial diagnostic techniques do not give conclusive diagnosis in some cases of pleural effusion. This group of patients described as patients with indeterminate or undiagnosed pleural effusion constitutes a significant proportion of patients with pleural effusion in clinical practice. In this study, we examined the role of video-assisted thoracoscopy (VAT) in the diagnostic work-up of these patients. To determine the diagnostic outcome of VAT in the management of indeterminate pleural effusion in our center. Consecutive patients who presented with pleural effusions and who met the inclusion criteria had video-assisted thoracoscopy for diagnostic purposes. Outcome measures including the diagnostic yield, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of VAT in patients with indeterminate pleural effusion, duration of the procedure, duration of hospitalization after the procedure, and complications for all the patients were documented and analyzed. Of the 22 patients with indeterminate pleural effusion, conclusive diagnosis was obtained in 18 (81.8%) with a sensitivity of 91.7% [95% confidence interval (CI); 61.5-99.8%], specificity of 100% (95% CI; 69.1-100%), PPV of 100% (95% CI; 0-100%), and NPV of 90.9% (95% CI; 60.5-98.5%) for malignancy and a sensitivity of 78% (95% CI; 40-97%), a specificity of 100% (95% CI; 75.3-100%), PPV of 100% (95% CI; 0-100%), and NPV of 86.7% (95% CI; 65.7-95.7%) for tuberculosis. Our results show that video-assisted thoracoscopy plays a useful role in our center in obtaining diagnosis in patients with indeterminate pleural effusion.

The Cost of Managing Pleural Effusion Associated with Dasatinib in CML Patients Post Imatinib Failure.

Pleural effusion is a life-threatening condition in dogs that can lead to acute respiratory distress if not promptly diagnosed and treated. These case series describe three dogs were presented with sudden onset of severe respiratory distress signs. A three-year-old male Great Dane, five-year-old male German shepherd and a six-year-old female indie dog were presented with rapid open mouth breathing, cyanosis of the tongue and marked respiratory distress. Immediate clinical examination suggested thoracic involvement, and later chest radiograph was taken to assess the thoracic cavity, lungs and heart. Radiographic findings revealed increases soft tissue opacity in thoracic cavity, border effacement of the cardiac silhouette and rounding of lung lobes leading to diagnosis of the pleural effusion. Emergency thoracocentesis performed in all cases resulting in rapid clinical improvement and stabilization of animals. These case reports highlight the importance of rapid recognition of clinical signs, the diagnostic value of the thoracic radiography, and the life-saving role of the thoracocentesis in the management of pleural effusion in dogs.

Advances in Pleural Disease Management Including Updated Procedural Coding

Background: Pleural effusions are a common complication following coronary artery bypass grafting (CABG) surgery. The presence of pleural effusion may impact post-operative outcomes, including mortality, respiratory complications, and recovery. This study aims to evaluate the prevalence and impact of pleural effusion within 30 days post-CABG and its association with clinical outcomes. Methods: This retrospective analysis utilized data from the TriNetX platform, including patients who underwent CABG with (CABG with pleural effusion: n=58,880) and without (CABG without pleural effusion: n=58,880) pleural effusion. Propensity score matching was performed to balance the baseline characteristics between the two cohorts with each cohort consisting of 58,880 patients. The primary outcome was 30-day all-cause mortality, while secondary outcomes included heart failure and respiratory failure. Kaplan-Meier survival curves were used to compare mortality between cohorts. Results: Patients with pleural effusion after CABG had significantly higher 30-day mortality than those without pleural effusion (13.5% vs. 2.9%; p<0.001). The hazard ratio for mortality in patients with pleural effusion was 4.96 (95% CI: 4.71-5.23). Additionally, patients in the pleural effusion cohort had an increased risk of heart failure (23% vs. 16%), and respiratory failure (3.8% vs. 2.2%). Conclusion: The presence of pleural effusion following CABG surgery is associated with significantly worse outcomes, including increased mortality, heart failure, and respiratory complications. Early identification and management of pleural effusion may be crucial to improving post-operative outcomes in this patient population.

The evidence base concerning the management of benign pleural effusions has lagged behind that of malignant pleural effusions in which recent randomised trials are now informing current clinical practice and international guidelines.The causes of benign pleural effusions are broad, heterogenous and patients may benefit from individualised management targeted at both treating the underlying disease process and direct management of the fluid. Pleural effusions are very common in a number of non-malignant pathologies, such as decompensated heart failure, and following coronary artery bypass grafting. Pleural fluid analysis forms an important basis of the diagnostic evaluation, and more specific assays and imaging modalities are helpful in specific subpopulations.Options for management beyond treatment of the underlying disorder, whenever possible, include therapeutically aspirating the fluid, talc pleurodesis and insertion of an indwelling pleural catheter. Randomised trials will inform clinicians in the future as to the risks and benefits of these options providing a guide as to how best to manage patient symptoms in this challenging clinical setting.

Serial Observation of Blood Alcohol Concentration post Ethanol Pleurodesis (SOBER) Study: A Prospective Observational Study

Épanchements pleuraux en réanimation

Useful clinical biological markers in diagnosis of pleural effusions in children

Background and objectivesBarking, Havering and Redbridge University Trust (BHRUT) serves a population of 750,000 patients with a large burden of pleural disease. Patients admitted and requiring pleural drainage usually results...

This column describes the etiology, diagnosis, and management of pleural effusions.

Management of pleural effusions is a common diagnostic and management problem. We reviewed the outcomes from pleural procedures after the instigation of pleural effusion management guidelines, focusing on pleural ultrasound and a hands-on teaching programme followed by procedure supervision that enabled many operators to perform such procedures. This is a retrospective analysis of all procedures performed for pleural effusions on medical patients. Outcomes were assessed prior to the instigation of pleural effusion management guidelines (pleural pathway) and hands-on teaching (January 2010 to June 2011) and following these interventions (January 2012 to June 2013). A total of 171 procedures involving 129 patients (pre-pathway group) and 146 procedures involving 115 patients (post-pathway group) was analysed. The rate of complications prior to the pleural pathway was 22.2% (38 of 171 procedures). Following the pathway, the rate of complications declined to 7.5% (11 of 146 procedures, P < 0.003). The use of pleural ultrasound increased dramatically (72.5 vs 90.2%). The number of patients who underwent repeated procedures (defined as ≥3) reduced dramatically (21 vs 7, P < 0.01). This improvement occurred using many supervised operators who completed the hands-on teaching programme (n = 32) and followed the pleural pathway (127 of 146 procedures). The instigation of a clinical pathway focused on the use of bedside pleural ultrasound, and teaching of drainage techniques with procedure supervision vastly improved patient outcomes. This not only allowed better quality of care for patients, it also provided the acquisition of new skills to medical staff, not limiting these skills to specialised staff.

Permanent Indwelling Catheters in the Management of Pleural Effusions

Decision Making and Algorithm for the Management of Pleural Effusions

In recent years, there has been an unprecedented drive for quality research in pleural disease, and advances in technology that have changed the landscape of interventional pulmonology, particularly for patients with undiagnosed pleural effusions.With a range of pleural procedures now available to the pulmonologist, the challenge is integrating these into a diagnostic and therapeutic pathway that is individualised to the patient's needs, while also providing expeditious diagnostic evaluation, limiting the number of procedures, and shifting care to the ambulatory setting.This review aims to summarise the important evidence related to pleural procedures, discuss their advantages and limitations, and describe their role in the management of undiagnosed pleural effusions.