Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, WA, Australia.
Pleural Medicine Unit, Institute for Respiratory Health, Perth, WA, Australia.
Respirology. 2020 Sep;25(9):963-971. doi: 10.1111/resp.13881. Epub 2020 Jul 1.
Pleural diseases affect millions of people worldwide. Pleural infection, malignant pleural diseases and pneumothorax are common clinical challenges. A large number of recent clinical trials have provided an evidence-based platform to evaluate conventional and novel methods to drain pleural effusions/air which reduce morbidity and unnecessary interventions. These successes have generated significant enthusiasm and raised the profile of pleural medicine as a new subspecialty. The ultimate goal of pleural research is to prevent/stop development of pleural effusions/pneumothorax. Current research studies mainly focus on the technical aspects of pleural drainage. Significant knowledge gaps exist in many aspects such as understanding of the pathobiology of the underlying pleural diseases, pharmacokinetics of pleural drug delivery, etc. Answers to these important questions are needed to move the field forward. This article collates opinions of leading experts in the field in highlighting major knowledge gaps in common pleural diseases to provoke thinking beyond pleural drainage. Recognizing the key barriers will help prioritize future research in the quest to ultimately cure (rather than just drain) these pleural conditions.
胸膜疾病影响着全球数百万人。胸膜感染、恶性胸膜疾病和气胸是常见的临床挑战。大量最近的临床试验提供了一个循证的平台，评估传统和新型的排液/排气方法，以降低发病率和不必要的干预。这些成功极大地激发了人们的热情，并提高了胸膜医学作为一个新的亚专科的地位。胸膜研究的最终目标是预防/阻止胸腔积液/气胸的发展。目前的研究主要集中在胸膜引流的技术方面。在许多方面，如对潜在胸膜疾病的病理生理学的理解、胸膜给药的药代动力学等，仍然存在着显著的知识空白。为了推动该领域的发展，需要回答这些重要问题。本文汇集了该领域的权威专家的意见，强调了常见胸膜疾病中的主要知识空白，以引发对胸膜引流之外的思考。认识到关键的障碍将有助于确定未来研究的优先次序，从而最终治愈（而不仅仅是引流）这些胸膜疾病。
