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Questions and Answers
What is the recommended acute management for minimally symptomatic or asymptomatic primary spontaneous pneumothorax in adults?
What is the recommended acute management for minimally symptomatic or asymptomatic primary spontaneous pneumothorax in adults?
What is the recommended initial treatment for primary spontaneous pneumothorax in adults?
What is the recommended initial treatment for primary spontaneous pneumothorax in adults?
Which intervention is recommended for preventing recurrent secondary spontaneous pneumothorax in adults with severe chronic obstructive pulmonary disease?
Which intervention is recommended for preventing recurrent secondary spontaneous pneumothorax in adults with severe chronic obstructive pulmonary disease?
When should thoracic surgery be considered for pneumothorax in adults?
When should thoracic surgery be considered for pneumothorax in adults?
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What is recommended for treating pneumothorax with persistent air leak in adults not fit for surgery?
What is recommended for treating pneumothorax with persistent air leak in adults not fit for surgery?
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How should imaging findings of unilateral pleural effusion be interpreted?
How should imaging findings of unilateral pleural effusion be interpreted?
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What is the recommended approach for initial treatment of primary spontaneous pneumothorax in adults with good support and expertise?
What is the recommended approach for initial treatment of primary spontaneous pneumothorax in adults with good support and expertise?
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When should chemical pleurodesis be considered for the prevention of recurrence of secondary spontaneous pneumothorax in adults?
When should chemical pleurodesis be considered for the prevention of recurrence of secondary spontaneous pneumothorax in adults?
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When should thoracic surgery be considered for the treatment of pneumothorax in adults at initial presentation?
When should thoracic surgery be considered for the treatment of pneumothorax in adults at initial presentation?
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What is vital for local ambulatory treatment pathways for pneumothorax in adults?
What is vital for local ambulatory treatment pathways for pneumothorax in adults?
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What methodology is used for guideline development in the BTS guideline for pleural disease?
What methodology is used for guideline development in the BTS guideline for pleural disease?
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How were clinical questions formulated in the BTS guideline for pleural disease?
How were clinical questions formulated in the BTS guideline for pleural disease?
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Who conducted systematic electronic database searches to identify relevant papers for the BTS guideline for pleural disease?
Who conducted systematic electronic database searches to identify relevant papers for the BTS guideline for pleural disease?
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What are recommendations in the BTS guideline for pleural disease based on?
What are recommendations in the BTS guideline for pleural disease based on?
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What volume of pleural fluid is recommended for cytological analysis in suspected malignant pleural effusion (MPE)?
What volume of pleural fluid is recommended for cytological analysis in suspected malignant pleural effusion (MPE)?
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What does a pleural fluid pH ≥7.4 imply?
What does a pleural fluid pH ≥7.4 imply?
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When is the use of an indwelling pleural catheter recommended for symptomatic MPE patients?
When is the use of an indwelling pleural catheter recommended for symptomatic MPE patients?
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What is the recommended approach for pleurodesis in MPE patients with <25% non-expandable lung?
What is the recommended approach for pleurodesis in MPE patients with <25% non-expandable lung?
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What is the aim of the BTS guideline for pleural disease?
What is the aim of the BTS guideline for pleural disease?
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What is the background of the pleural disease guideline?
What is the background of the pleural disease guideline?
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What is the purpose of the full guideline published as a separate Thorax Supplement?
What is the purpose of the full guideline published as a separate Thorax Supplement?
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What does the BTS guideline for pleural disease aim to provide?
What does the BTS guideline for pleural disease aim to provide?
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Who were the lead authors responsible for the final document of the Thorax 2023 Guideline?
Who were the lead authors responsible for the final document of the Thorax 2023 Guideline?
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Which criteria are used to determine if pleural fluid is an exudate in the guideline?
Which criteria are used to determine if pleural fluid is an exudate in the guideline?
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Where is the Thorax 2023 Guideline available?
Where is the Thorax 2023 Guideline available?
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Which clinical pathways/decision trees are included in the Thorax 2023 Guideline?
Which clinical pathways/decision trees are included in the Thorax 2023 Guideline?
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What is the aim of the British Thoracic Society (BTS) Guideline for pleural disease?
What is the aim of the British Thoracic Society (BTS) Guideline for pleural disease?
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Where can the full BTS Guideline for pleural disease be accessed?
Where can the full BTS Guideline for pleural disease be accessed?
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What does pleural disease represent in the medical field?
What does pleural disease represent in the medical field?
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Why was the BTS Guideline for pleural disease developed?
Why was the BTS Guideline for pleural disease developed?
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Which criteria are used to determine if pleural fluid is an exudate?
Which criteria are used to determine if pleural fluid is an exudate?
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Where is the guideline available?
Where is the guideline available?
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Which institutions and contributors were involved in developing the guideline?
Which institutions and contributors were involved in developing the guideline?
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Who were the lead authors responsible for the final document?
Who were the lead authors responsible for the final document?
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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.
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Description
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.
