Medicina basada en evidencia.

...

ARTÍCULOS DE INTERÉS

Titulo

Fuente (1) / URL (2)

Management of a malignant pleural effusion: British Thoracic Society Pleural Disease Guideline 2010.

http://thorax.bmj.com/content/65/Suppl_2/ii32

Investigation of a unilateral pleural effusion in adults: British Thoracic Society Pleural Disease Guideline 2010.

http://thorax.bmj.com/content/65/Suppl_2/ii4

Management of pleural infection in adults: British Thoracic Society Pleural Disease Guideline 2010.

http://thorax.bmj.com/content/65/Suppl_2/ii41

BTS guidelines for the management of malignant pleural effusions.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1766015/?tool=pubmed

ARTÍCULO ELEGIDO

Resumen

BTS GUIDELINES FOR THE MANAGEMENT OF MALIGNANT PLEURAL EFFUSIONS

G Antunes, E Neville, J Duffy, N Ali, On Behalf Of The Bts Pleural Disease Group, A Subgroup Of The Bts Standards Of Care Committee

Artículo en Inglés | pesquisa |

MANAGEMENT OPTIONS

Treatment options for malignant pleural effusions are determined by several factors: symptoms and performance status of the patient, the primary tumour and its response to systemic therapy, and lung re-expansion following pleural fluid evacuation (table 2). Although small cell lung cancer, lymphoma, and breast cancer usually respond to chemotherapy, associated secondary pleural effusions may require intervention during the course of treatment. Common and less common management options will be discussed below.

4.1 Observation •

Observation is recommended if the patient is asymptomatic or there is no recurrence of symptoms after initial thoracentesis. [C] •

Advice should be sought from the thoracic malignancy multidisciplinary team for symptomatic or recurrent malignant effusions. [C] The majority of these patients will become symptomatic in due course and require further intervention. There is no evidence that initial thoracentesis carried out according to standard technique will reduce the chances of subsequent effective pleurodesis.

4.2 Therapeutic pleural aspiration

• Repeat pleural aspiration is recommended for the palliation of breathlessness in patients with a very short life expectancy. [C]

• Caution should be taken if removing more than 1.5 l on a single occasion. [C]

• The recurrence rate at 1 month after pleural aspiration alone is close to 100%. [B]

• Intercostal tube drainage without pleurodesis is not recommended because of a high recurrence rate. [B]

Repeated therapeutic pleural aspiration provides transient relief of symptoms and avoids hospitalisation for patients with limited survival expectancy and poor performance status. This option is appropriate for frail or terminally ill patients but individual patient preference may also dictate its use in patients who have had a previous failed intercostal tube and pleurodesis.20 The amount of fluid evacuated will be guided by patient symptoms (cough, chest discomfort) and should be limited to 1–1.5 l (see section 4.3.2). Pleural aspiration alone and intercostal tube drainage without instillation of a sclerosant are associated with a high recurrence rate and a small risk of iatrogenic pneumothorax and empyema.21–2

4.3.4 Selecting a sclerosing agent

• Talc is the most effective sclerosant available for pleurodesis. [B]

• A small number of patients (respiratory failure following talc administration. [B]

• Tetracycline is modestly effective, has few severe side effects, and is the preferred sclerosant to minimize adverse event rates. [B]

• Bleomycin is an alternative sclerosant with a modest efficacy rate but is expensive. [B]

• Pleuritic chest pain and fever are the most common side effects of sclerosant administration. [B]

DICCIONARIO

Palabra en Inglés

Frase

Traducción al español de la frase

ADVICE

My advice is not to marry him

Mi consejo es que no te cases con él

SHORT

This holidays have been a short time to enjoy with family

Estas vacaciones han sido poco tiempo para disfrutar con la familia

EXPENSIVE

These earrings are too expensive

Estos pendientes son demasiado caros

FEVER

Fever keeps me awake

La fiebre no me deja dormir

Clasificación de la tabla 1 de recomendaciones de la dirección ("viñetas")

- (Apoyado por papel () de niveles Ia o Ib)). Requiere al menos un juicio aleatorio como la parte de un cuerpo de la literatura de buena calidad total y consecuencia dirigiéndose a la recomendación específica

- (Apoyado por papel () de niveles IIa, IIb, III). Requiere la disponibilidad de investigaciones clínicas bien conducidas, pero ningunos ensayos clínicos aleatorios en el tema de recomendación (o juicios aleatorios pobres/inadecuados no apoyados por otra literatura suficiente para conseguir el grado A).

- (Apoyado por pruebas del nivel IV). Requiere pruebas de informes del comité expertos u opiniones y/o experiencia clínica de