34 Questions
What is the recommended acute management for minimally symptomatic or asymptomatic primary spontaneous pneumothorax in adults?
Conservative management
What is the recommended initial treatment for primary spontaneous pneumothorax in adults?
Ambulatory management
Which intervention is recommended for preventing recurrent secondary spontaneous pneumothorax in adults with severe chronic obstructive pulmonary disease?
Chemical pleurodesis
When should thoracic surgery be considered for pneumothorax in adults?
Only for those at risk of recurrence
What is recommended for treating pneumothorax with persistent air leak in adults not fit for surgery?
Autologous blood pleurodesis
How should imaging findings of unilateral pleural effusion be interpreted?
In the context of clinical history and knowledge of pleural fluid characteristics
What is the recommended approach for initial treatment of primary spontaneous pneumothorax in adults with good support and expertise?
Conservative management
When should chemical pleurodesis be considered for the prevention of recurrence of secondary spontaneous pneumothorax in adults?
Only in cases of persistent air leak
When should thoracic surgery be considered for the treatment of pneumothorax in adults at initial presentation?
Only in cases of persistent air leak
What is vital for local ambulatory treatment pathways for pneumothorax in adults?
Planning and coordination between the emergency department, general medicine, and respiratory medicine
What methodology is used for guideline development in the BTS guideline for pleural disease?
GRADE methodology
How were clinical questions formulated in the BTS guideline for pleural disease?
PICO framework
Who conducted systematic electronic database searches to identify relevant papers for the BTS guideline for pleural disease?
The University of York and BTS Head Office
What are recommendations in the BTS guideline for pleural disease based on?
Quality of evidence, balance of desirable and undesirable outcomes, and patient/carers' values and preferences
What volume of pleural fluid is recommended for cytological analysis in suspected malignant pleural effusion (MPE)?
25-50 mL
What does a pleural fluid pH ≥7.4 imply?
Low risk of CPPE or pleural infection
When is the use of an indwelling pleural catheter recommended for symptomatic MPE patients?
When >25% non-expandable lung is present
What is the recommended approach for pleurodesis in MPE patients with <25% non-expandable lung?
Talc slurry pleurodesis
What is the aim of the BTS guideline for pleural disease?
To provide evidence-based guidance on the investigation and management of pleural disease
What is the background of the pleural disease guideline?
Pleural disease is common and represents a major and rapidly developing subspecialty that presents to many different hospital services
What is the purpose of the full guideline published as a separate Thorax Supplement?
To provide detailed information about each section of the guideline
What does the BTS guideline for pleural disease aim to provide?
Good practice points (GPPs) in addition to guideline recommendations
Who were the lead authors responsible for the final document of the Thorax 2023 Guideline?
MER, NMR, and NAM
Which criteria are used to determine if pleural fluid is an exudate in the guideline?
Light's criteria
Where is the Thorax 2023 Guideline available?
British Thoracic Society and the Thorax journal
Which clinical pathways/decision trees are included in the Thorax 2023 Guideline?
Pneumothorax and unilateral pleural effusion
What is the aim of the British Thoracic Society (BTS) Guideline for pleural disease?
To provide evidence-based guidance on the investigation and management of pleural disease
Where can the full BTS Guideline for pleural disease be accessed?
From the BTS website
What does pleural disease represent in the medical field?
A major and rapidly developing subspecialty
Why was the BTS Guideline for pleural disease developed?
To provide evidence-based guidance on the investigation and management of pleural disease
Which criteria are used to determine if pleural fluid is an exudate?
Light's criteria
Where is the guideline available?
British Thoracic Society and the Thorax journal
Which institutions and contributors were involved in developing the guideline?
Multiple institutions and contributors across the UK and Australia
Who were the lead authors responsible for the final document?
MER, NMR, and NAM
Study Notes
Optimal Management of Pneumothorax and Unilateral Pleural Effusion
- Ambulatory management is recommended as the initial treatment for primary spontaneous pneumothorax in adults, with good support and available expertise.
- Needle aspiration or tube drainage should be considered for patients not suitable for conservative or ambulatory management of primary spontaneous pneumothorax.
- Chemical pleurodesis is recommended for preventing recurrent secondary spontaneous pneumothorax in adults with severe chronic obstructive pulmonary disease.
- Thoracic surgery is an option for initial presentation of pneumothorax in adults, especially for those at risk of recurrence or in high-risk occupations.
- Local ambulatory treatment pathways require planning and coordination between the emergency department, general medicine, and respiratory medicine.
- Adequate analgesia should be provided before and after performing chemical pleurodesis for pneumothorax in adults.
- Patients should be involved in treatment option discussions to determine their main priority, considering the least invasive option.
- Elective surgery may be considered for patients at risk of recurrence or those who develop tension pneumothorax at the first episode.
- Discharge and activity advice should be given to all patients post-pneumothorax.
- Autologous blood pleurodesis or endobronchial therapies should be considered for treating pneumothorax with persistent air leak in adults not fit for surgery.
- Video-assisted thoracoscopy access is recommended for surgical pleurodesis in the general management of pneumothorax in adults.
- Imaging findings of unilateral pleural effusion should be interpreted in the context of clinical history and knowledge of pleural fluid characteristics.
Thorax 2023 Guideline Summary
- The guideline was developed by multiple institutions and contributors across the UK and Australia.
- The lead authors responsible for the final document were MER, NMR, and NAM.
- No specific grant for this research was declared, and there were no competing interests among the authors.
- Declarations of Interests forms were completed by all members for each year they were part of the GDG.
- The guidelines were internally peer-reviewed and were commissioned.
- The guideline references previous British Thoracic Society guidelines and BMJ Best Practice.
- The guideline includes clinical pathways/decision trees for pneumothorax and unilateral pleural effusion.
- The unilateral pleural effusion diagnostic pathway involves tests such as CXR, FBC, LDH, NT-proBNP, and TUS.
- Light's criteria are used to determine if pleural fluid is an exudate.
- The guideline is available through the British Thoracic Society and the Thorax journal.
- The guideline's focus includes the investigation and management of pleural diseases such as pleural effusion, pneumothorax, and pleural infection.
- The guideline also covers the management of malignant pleural effusion and pleural procedures.
Test your knowledge of the optimal management of pneumothorax and unilateral pleural effusion with this quiz. From ambulatory management to surgical options, this quiz covers the key aspects of treatment pathways and considerations for these respiratory conditions.
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