School of Health and Medical Sciences, Edith Cowan University, Perth, Western Australia, Australia.
Department of Surgery, St Vincent's Hospital, Melbourne, Victoria, Australia.
Intern Med J. 2024 Jul;54(7):1119-1125. doi: 10.1111/imj.16366. Epub 2024 Apr 1.
Malignant pleural effusions (MPEs) are common, and a third of them have underlying trapped lung (TL). Management of MPE and TL is suspected to be heterogeneous. Understanding current practices in Australasia is important in guiding policies and future research.
Electronic survey of Australia-New Zealand respiratory physicians, thoracic surgeons and their respective trainees to determine practice of MPE and TL management.
Of the 132 respondents, 56% were respiratory physicians, 23% were surgeons and 20% were trainees. Many respondents defined TL as >25% or any level of incomplete lung expansion; 75% would use large-volume thoracentesis to determine whether TL was present. For patients with TL, indwelling pleural catheters (IPCs) were the preferred treatment irrespective of prognosis. In those without TL, surgical pleurodesis was the most common choice if prognosis was >6 months, whereas IPC was the preferred option if survival was <3 months. Only 5% of respondents considered decortication having a definite role in TL, but 55% would consider it in select cases. Forty-nine per cent of surgeons would not perform decortication when the lung does not fully expand intra-operatively. Perceived advantages of IPCs were minimisation of hospital time, effusion re-intervention and usefulness irrespective of TL status. Perceived disadvantages of IPCs were lack of suitable drainage care, potentially indefinite duration of catheter-in-situ and catheter complications.
This survey highlights the lack of definition of TL and heterogeneity of MPE management in Australasia, especially for patients with expandable lungs. This survey also identified the main hurdles of IPC use that should be targeted.
恶性胸腔积液（MPE）很常见，其中三分之一有潜在的肺不张（TL）。MPE 和 TL 的治疗方法被怀疑存在异质性。了解澳大利亚-新西兰的当前实践情况对于指导政策和未来的研究非常重要。
对澳大利亚-新西兰的呼吸科医生、胸外科医生及其各自的受训者进行电子调查，以确定 MPE 和 TL 管理的实践情况。
在 132 名受访者中，56%是呼吸科医生，23%是外科医生，20%是受训者。许多受访者将 TL 定义为 >25%或任何程度的不完全肺扩张；75%会使用大容量胸腔穿刺术来确定 TL 是否存在。对于有 TL 的患者，留置胸腔引流管（IPC）是首选治疗方法，无论预后如何。对于没有 TL 的患者，如果预后 >6 个月，则最常选择外科胸膜固定术，如果生存时间 <3 个月，则首选 IPC。只有 5%的受访者认为去皮质术在 TL 中有明确的作用，但 55%会在选择病例中考虑。50%的外科医生在肺不能完全扩张时不会进行去皮质术。IPC 的主要优点是减少住院时间、胸腔积液再干预和无论 TL 状态如何都有用。IPC 的主要缺点是缺乏合适的引流护理、导管潜在的无限期留置和导管并发症。
这项调查突出了澳大利亚-新西兰对 TL 的定义缺乏共识，以及 MPE 管理方法的异质性，尤其是对可扩张肺的患者。这项调查还确定了 IPC 使用的主要障碍，应该针对这些障碍进行研究。
