pulmonary disorders
Pleural Effusion
Treatment of Pleural Effusion
Treatment of symptoms and underlying disorder Drainage of some symptomatic effusions Other treatments for parapneumonic and malignant effusions The effusion itself generally does not require treatment if it is asymptomatic because many effusions resorb spontaneously when the underlying disorder is treated, especially effusions due to uncomplicated pneumonias, pulmonary embolism, or surgery. Pleuritic pain can usually be managed with nonsteroidal anti-inflammatory drugs (NSAIDs) or other oral analgesics. At times, a short course of oral opioids is required. How To Do Thoracentesis (usually around 1 to 1.5 L in a single treatment) is sufficient for many symptomatic effusions and can be repeated for effusions that reaccumulate. There are no arbitrary limits on the amount of fluid that can be removed ( Effusions that are chronic, recurrent, and causing symptoms can be treated with pleurodesis or by intermittent drainage with an indwelling catheter. Effusions caused by pneumonia or cancer may require additional specific measures. 60 mg/dL [< 3.33 mmol/L], positive Gram stain or culture, loculations), the effusion should be completely drained via How To Do Thoracentesis or If dyspnea caused by malignant pleural effusion is relieved by thoracentesis but fluid and dyspnea redevelop, chronic (intermittent) drainage or pleurodesis is indicated. Asymptomatic effusions and effusions causing dyspnea unrelieved by thoracentesis do not require additional procedures. Indwelling pleural catheters and pleurodesis are equally effective for treating malignant pleural effusion. Choice depends on patient preference. Both decrease dyspnea and improve quality of life effectively.Talcpleurodesis requires hospital admission but long-term complications are more frequent with indwelling catheters. Pleurodesis is done by instilling a sclerosing agent into the pleural space to fuse the visceral and parietal pleura and eliminate the space. The most effective and commonly used sclerosing agents aretalc,doxycycline, andbleomycindelivered via chest tube or thoracoscopy. Pleurodesis is contraindicated if the lung does not expand after full drainage with a chest tube (entrapped lung), in which case indwelling pleural catheter is indicated. Shunting of pleural fluid to the peritoneum (pleuroperitoneal shunt) is rarely done but is an option in patients who have trapped lung. Surgical treatment (pleurectomy or decortication) should be considered in patients with trapped lung who have good performance status and a good prognosis. 1.Feller-Kopman D, Berkowitz D, Boiselle P, et al: Large-volume thoracentesis and the risk of reexpansion pulmonary edema.Ann Thoracic Surg84:1656–1662, 2007. 