Hospital Medicine

Pleural Disease

Questions discussed in this category

Would you consider deferring chest tube placement in a clinically stable patient with a small empyema without signs of systemic infection?

2 Answers available

Is a larger bore percutaneous chest tube sufficient to adequately drain a hemothorax, or is a surgical chest tube required?

1 Answer available

What is your approach to the evaluation and management of a suspected intrapulmonary hematoma?

1 Answer available

Do you use intrapleural tPA/dornase in loculated effusions that are not due to infection?

1 Answer available

How do you assess the use of Heimlich valves for patients who present with persistent air leaks?

1 Answer available

What is your approach to the management of persistent hydropneumothorax due to a non expandable lung?

1 Answer available

Is an early chest tube and tPA/Dornase therapy for a loculated and complex pleural effusion that is not an empyema or hemothorax helpful in reducing the rate of developing trapped lung?

1 Answer available

Do you routinely continue using TPA/Dornase for treatment of empyema, if there is accumulation of new sero-sanguinous output from the chest tube after the initial treatment?

Are there any quantitative indices (eg. volume, pleural fluid hematocrit) that would impact your decision to stop subsequent TPA/dornase treatments?

1 Answer available

How do you approach treatment of septated parapneumonic pleural effusions that do not satisfy traditional criteria for complicated effusion after diagnostic thoracentesis?

Is there any role of tube thoracostomy as opposed to only antibiotics?

1 Answer available

Do you perform a clamp trial before removing a chest tube for pneumothorax?

2 Answers available

Do you give intrapleural lytics for complicated effusion/empyema in patients on systemic anticoagulation?

1 Answer available

Do you recommend the use of endobronchial valves in the management of patients with spontaneous pneumothorax with persistent air leak?

1 Answer available

Do you recommend the use of indwelling pleural catheters in the management of patients with hepatic hydrothorax requiring frequent drainage?

1 Answer available

Papers discussed in this category

J Bronchology Interv Pulmonol, 2021 Nov 10

Indwelling Pleural Catheter (IPC) for the Management of Hepatic Hydrothorax: The Known and the Unknown.

Chest, 2015-09

Intrapleural Fibrinolysis for the Treatment of Indwelling Pleural Catheter-Related Symptomatic Loculations: A Multicenter Observational Study.

J Thorac Dis,

The use of thrombolytics in the management of complex pleural fluid collections.

N Engl J Med,

Intrapleural use of tissue plasminogen activator and DNase in pleural infection.

BMC Res Notes, 2020 Aug 03

Clinical efficacy and bleeding outcomes of tissue plasminogen activator and dornase alfa in pleural space infection with once daily concurrent administration: a retrospective cohort study.

Respirology, 2022 Apr 19

Alteplase Dose Assessment for Pleural infection Therapy (ADAPT) Study-2: Use of 2.5 mg alteplase as a starting intrapleural dose.

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