From the Guidelines
For patients with symptomatic malignant pleural effusions, the most effective definitive treatment is either an indwelling pleural catheter (IPC) or chemical pleurodesis, as recommended by the American Journal of Respiratory and Critical Care Medicine in 2018 1. When managing pleural effusions, it's crucial to consider the underlying cause and the patient's symptoms.
- For symptomatic effusions, thoracentesis is often the initial step to drain the fluid and provide relief.
- In cases of malignant pleural effusions, pleurodesis using talc (4-5g) or doxycycline (500mg) can be effective in preventing recurrence 1.
- The use of diuretics like furosemide 20-40mg daily can help manage effusions caused by heart failure.
- Inflammatory effusions may respond to corticosteroids such as prednisone 0.5-1mg/kg daily.
- For patients with symptomatic malignant pleural effusions and expandable lung, either an indwelling pleural catheter (IPC) or chemical pleurodesis is suggested as first-line definitive pleural intervention 1.
- In cases where the lung is nonexpandable, failed pleurodesis, or loculated effusion, the use of IPCs is preferred over chemical pleurodesis 1.
- It's essential to monitor patients for respiratory distress, fever, and chest pain, and to address any complications promptly to prevent respiratory compromise and pleural fibrosis.
From the FDA Drug Label
1.INDICATIONS AND USAGE 1.1 Malignant Pleural Effusion STERITALC is indicated to decrease the recurrence of malignant pleural effusions in symptomatic patients following maximal drainage of the pleural effusion. 14. 1 Malignant Pleural Effusion The data demonstrating safety and efficacy of talc in the treatment of malignant pleural effusions are derived from the published medical literature In these studies, greater than 1000 patients with malignant pleural effusions have been reported (with varying degrees of detail and durations of response) to have had successful pleurodesis with talc, administered either by poudrage or as a slurry via chest tube There are published efficacy data for more than 200 patients treated with STERITALC for malignant pleural effusion, with a success rate of approximately 89% (range 73-91%).
Pleural Effusion is a condition that can be treated with STERITALC (talc), which is indicated to decrease the recurrence of malignant pleural effusions in symptomatic patients following maximal drainage of the pleural effusion 2. The treatment has a success rate of approximately 89% in patients with malignant pleural effusion 2. STERITALC is specifically indicated for this use, as stated in the drug label 2.
- Key Points:
- STERITALC is used to treat malignant pleural effusions.
- The treatment has a success rate of approximately 89%.
- STERITALC is indicated for use in symptomatic patients following maximal drainage of the pleural effusion.
From the Research
Definition and Causes of Pleural Effusion
- Pleural effusion is an excessive accumulation of fluid in the pleural space, which can be related to disorders of the lung or pleura, or to a systemic disorder 3.
- The most common causes of pleural effusions are pneumonia, congestive heart failure, and malignancy 4.
- Other causes of pleural effusion include heart failure, infection, malignancy, and pulmonary embolism 5.
Symptoms and Diagnosis of Pleural Effusion
- Patients with pleural effusion commonly present with dyspnea, initially on exertion, predominantly dry cough, and pleuritic chest pain 3.
- The diagnostic evaluation of pleural effusion includes chemical and microbiological studies, as well as cytological analysis, which can provide further information about the etiology of the disease process 3.
- Point-of-care ultrasound and chest radiography are recommended for evaluating the pleural space, with ultrasonography guiding thoracentesis to reduce complications 5.
- Light's criteria can help differentiate exudates from transudates, and pleural aspirate should be evaluated using Gram stain, cell count with differential, culture, cytology, protein, l-lactate dehydrogenase, and pH levels 5.
Treatment and Management of Pleural Effusion
- The treatment of pleural effusion depends on its etiology, with transudative effusions usually managed by treating the underlying medical disorder 3.
- Exudative effusions require specific treatment, such as drainage and pleurodesis for malignant effusions, and antibiotics and intercostal drainage for empyemas 3, 6.
- Percutaneous closed pleural biopsy is recommended for evaluation and exclusion of various etiologies, such as tuberculosis or malignant disease 3.
- The proper treatment of pleural effusion can be determined only after meticulous differential diagnosis, and the range of therapeutic options has recently become much wider 6.