Treatment of Clinically Significant Pleural Effusion in Confirmed MPE with Non-Expandable (Trapped) Lung

This protocol addresses symptomatic clinically significant pleural effusion in patients with a confirmed malignant pleural effusion (MPE) in whom the lung is non-expandable (trapped). This includes cases where non-expandable lung is radiologically significant — defined as greater than 25% on imaging — as well as less extensive degrees of lung trapping.

When the lung fails to re-expand after pleural fluid drainage, standard pleurodesis approaches may not be suitable, and intervention strategy must account for this.

The choice of intervention depends on the degree of non-expandable lung. In cases where non-expandable lung is radiologically significant, a catheter-based drainage approach is favoured over pleurodesis. Symptomatic assessment may be undertaken before committing to a definitive drainage strategy.

The complete decision algorithm — including selection criteria between drainage options, the role of surgical intervention in selected patients, and how treatment is individualised — is available in the full structured protocol.