Miller Russell J, Chrissian Ara A, Lee Y C Gary, Rahman Najib M, Wahidi Momen M, Tremblay Alain, Hsia David W, Almeida Francisco A, Shojaee Samira, Mudambi Lakshmi, Belanger Adam R, Bedi Harmeet, Gesthalter Yaron B, Gaynor Margaret, MacKenney Karen L, Lewis Sandra Z, Casal Roberto F
Department of Pulmonary Medicine, Naval Medical Center San Diego.
Department of Medicine, University of California San Diego, San Diego.
J Bronchology Interv Pulmonol. 2020 Oct;27(4):229-245. doi: 10.1097/LBR.0000000000000707.
While the efficacy of Indwelling pleural catheters for palliation of malignant pleural effusions is supported by relatively robust evidence, there is less clarity surrounding the postinsertion management.
The Trustworthy Consensus-Based Statement approach was utilized to develop unbiased, scientifically valid guidance for the management of patients with malignant effusions treated with indwelling pleural catheters. A comprehensive electronic database search of PubMed was performed based on a priori crafted PICO questions (Population/Intervention/Comparator/Outcomes paradigm). Manual searches of the literature were performed to identify additional relevant literature. Dual screenings at the title, abstract, and full-text levels were performed. Identified studies were then assessed for quality based on a combination of validated tools. Appropriateness for data pooling and formation of evidence-based recommendations was assessed using predetermined criteria. All panel members participated in development of the final recommendations utilizing the modified Delphi technique.
A total of 7 studies were identified for formal quality assessment, all of which were deemed to have a high risk of bias. There was insufficient evidence to allow for data pooling and formation of any evidence-based recommendations. Panel consensus resulted in 11 ungraded consensus-based recommendations.
This manuscript was developed to provide clinicians with guidance on the management of patients with indwelling pleural catheters placed for palliation of malignant pleural effusions. Through a systematic and rigorous process, management suggestions were developed based on the best available evidence with augmentation by expert opinion when necessary. In addition, these guidelines highlight important gaps in knowledge which require further study.
虽然留置胸膜导管缓解恶性胸腔积液的疗效有相对确凿的证据支持，但导管插入后的管理尚不太明确。
采用基于可靠共识的声明方法，为接受留置胸膜导管治疗的恶性胸腔积液患者的管理制定无偏倚、科学有效的指南。根据预先制定的PICO问题（人群/干预措施/对照/结局范式）对PubMed进行全面的电子数据库检索。对文献进行人工检索以识别其他相关文献。在标题、摘要和全文层面进行双重筛选。然后根据多种经过验证的工具对纳入的研究进行质量评估。使用预定标准评估数据合并和形成循证建议的适宜性。所有小组成员利用改良的德尔菲技术参与最终建议的制定。
共确定7项研究进行正式质量评估，所有研究均被认为存在高偏倚风险。没有足够的证据进行数据合并和形成任何循证建议。小组共识产生了11条基于共识的未分级建议。
撰写本文是为了给临床医生提供有关为缓解恶性胸腔积液而置入留置胸膜导管患者管理的指导。通过系统且严格的过程，基于现有最佳证据并在必要时借助专家意见制定了管理建议。此外，这些指南突出了需要进一步研究的重要知识空白。
