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Management of Malignant Pleural Effusions. An Official ATS/STS/STR Clinical Practice Guideline.

Publication ,  Journal Article
Feller-Kopman, DJ; Reddy, CB; DeCamp, MM; Diekemper, RL; Gould, MK; Henry, T; Iyer, NP; Lee, YCG; Lewis, SZ; Maskell, NA; Rahman, NM ...
Published in: Am J Respir Crit Care Med
October 1, 2018

BACKGROUND: This Guideline, a collaborative effort from the American Thoracic Society, Society of Thoracic Surgeons, and Society of Thoracic Radiology, aims to provide evidence-based recommendations to guide contemporary management of patients with a malignant pleural effusion (MPE). METHODS: A multidisciplinary panel developed seven questions using the PICO (Population, Intervention, Comparator, and Outcomes) format. The GRADE (Grading of Recommendations, Assessment, Development and Evaluation) approach and the Evidence to Decision framework was applied to each question. Recommendations were formulated, discussed, and approved by the entire panel. RESULTS: The panel made weak recommendations in favor of: 1) using ultrasound to guide pleural interventions; 2) not performing pleural interventions in asymptomatic patients with MPE; 3) using either an indwelling pleural catheter (IPC) or chemical pleurodesis in symptomatic patients with MPE and suspected expandable lung; 4) performing large-volume thoracentesis to assess symptomatic response and lung expansion; 5) using either talc poudrage or talc slurry for chemical pleurodesis; 6) using IPC instead of chemical pleurodesis in patients with nonexpandable lung or failed pleurodesis; and 7) treating IPC-associated infections with antibiotics and not removing the catheter. CONCLUSIONS: These recommendations, based on the best available evidence, can guide management of patients with MPE and improve patient outcomes.

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Published In

Am J Respir Crit Care Med

DOI

EISSN

1535-4970

Publication Date

October 1, 2018

Volume

198

Issue

7

Start / End Page

839 / 849

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Tomography, X-Ray Computed
  • Thoracentesis
  • Talc
  • Societies, Medical
  • Severity of Illness Index
  • Respiratory System
  • Randomized Controlled Trials as Topic
  • Radiography, Thoracic
  • Prognosis
 

Citation

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Feller-Kopman, D. J., Reddy, C. B., DeCamp, M. M., Diekemper, R. L., Gould, M. K., Henry, T., … Balekian, A. A. (2018). Management of Malignant Pleural Effusions. An Official ATS/STS/STR Clinical Practice Guideline. Am J Respir Crit Care Med, 198(7), 839–849. https://doi.org/10.1164/rccm.201807-1415ST
Feller-Kopman, David J., Chakravarthy B. Reddy, Malcolm M. DeCamp, Rebecca L. Diekemper, Michael K. Gould, Travis Henry, Narayan P. Iyer, et al. “Management of Malignant Pleural Effusions. An Official ATS/STS/STR Clinical Practice Guideline.Am J Respir Crit Care Med 198, no. 7 (October 1, 2018): 839–49. https://doi.org/10.1164/rccm.201807-1415ST.
Feller-Kopman DJ, Reddy CB, DeCamp MM, Diekemper RL, Gould MK, Henry T, et al. Management of Malignant Pleural Effusions. An Official ATS/STS/STR Clinical Practice Guideline. Am J Respir Crit Care Med. 2018 Oct 1;198(7):839–49.
Feller-Kopman, David J., et al. “Management of Malignant Pleural Effusions. An Official ATS/STS/STR Clinical Practice Guideline.Am J Respir Crit Care Med, vol. 198, no. 7, Oct. 2018, pp. 839–49. Pubmed, doi:10.1164/rccm.201807-1415ST.
Feller-Kopman DJ, Reddy CB, DeCamp MM, Diekemper RL, Gould MK, Henry T, Iyer NP, Lee YCG, Lewis SZ, Maskell NA, Rahman NM, Sterman DH, Wahidi MM, Balekian AA. Management of Malignant Pleural Effusions. An Official ATS/STS/STR Clinical Practice Guideline. Am J Respir Crit Care Med. 2018 Oct 1;198(7):839–849.

Published In

Am J Respir Crit Care Med

DOI

EISSN

1535-4970

Publication Date

October 1, 2018

Volume

198

Issue

7

Start / End Page

839 / 849

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Tomography, X-Ray Computed
  • Thoracentesis
  • Talc
  • Societies, Medical
  • Severity of Illness Index
  • Respiratory System
  • Randomized Controlled Trials as Topic
  • Radiography, Thoracic
  • Prognosis