Malignant Pleural Effusions: Management Options

David J. McCracken, MRCP; Jose M. Porcel, MD; Najib M. Rahman, DPhil


Semin Respir Crit Care Med. 2018;39(6):704-712. 

In This Article

Long-term Management: Intercostal Chest Drain and Talc Pleurodesis

The high rate of pleural effusion recurrence following simple aspiration means that long-term management must be considered. Prior to the advent and widespread use of IPCs, pleural fluid drainage and talc pleurodesis were considered as the exclusive traditional first-line definitive management option for MPE. This position is reflected in the BTS Pleural Disease Guidelines originally published in 2010.[1]

A number of drawbacks associated with pleurodesis remain. These include recognized failure rates of around 30%,[19] the requirement for adequate visceral and parietal pleural apposition which is not possible in patients with unexpandable lung, along with an associated mean length of inpatient stay of 5 to 7 days.[19] Other documented adverse effects include fever and pain.[20]