Treatment of Clinically Significant Pleural Effusion in Confirmed Malignant Pleural Effusion (MPE) with Expandable Lung
This protocol addresses the management of clinically significant pleural effusion in patients with a confirmed malignant pleural effusion (MPE) where no non-expandable lung has been identified.
Clinical scenario: Confirmed malignant pleural effusion (MPE) with expandable lung (no known non-expandable lung). Patients in this setting should be offered a choice between first-line interventional approaches to manage the effusion and relieve symptoms.
Treatment approach (partial)
Where drainage is complicated by septation, an intrapleural fibrinolytic strategy may be considered to improve drainage and relieve breathlessness. The full protocol specifies the selection criteria, intervention sequence, and clinical decision points.
References
DOI: 10.1136/thorax-2023-220304
- Patients without known non-expandable lung should be offered a choice of indwelling pleural catheter (IPC) or pleurodesis as first line intervention in the management of MPE.
- Intrapleural fibrinolytics may be used in patients with MPE and septated effusion and an indwelling pleural catheter (IPC) to improve drainage if flushing the IPC with normal saline or heparinised saline does not improve drainage.
- Intrapleural fibrinolytics can be considered in highly selected symptomatic patients with MPE to try to improve breathlessness.