Paraneumonic Effusions
Guidelines Rank: 2
Date of Annual Review: 2006
Abstract
Evidence:The literature review revealed 24 articles eligible for full review by the panel, 19 of which dealt with the primary management approach to PPE and 5 with a rescue approach after a previous approach had failed. Of the 19 involving the primary management approach to PPE, there were 3 randomized, controlled trials, 2 historically controlled series, and 14 case series. The number of patients included in the randomized controlled trials was small; methodologic weaknesses were found in the 19 articles describing the results of primary management approaches to PPE. The proportion and 95% CI of patients suffering each of the two relevant outcomes (death and need for a second intervention to manage the PPE) were calculated for the pooled data for each management approach from the 19 articles on the primary management approach. The pooled proportion of deaths was higher for the no drainage (6.6%), therapeutic thoracentesis (10.3%), and tube thoracostomy management approaches (8.8%) than for the fibrinolytic (4.3%), VATS (4.8%), and surgery (1.9%) approaches, but the 95% CI showed considerable overlap among all six possible primary management approaches. The pooled proportion of patients needing a second intervention to manage the PPE was also higher for the no drainage (49.2%), therapeutic thoracentesis (46.3%), and tube thoracostomy (40.3%) management approaches than the fibrinolytic (14.9%), VATS (0%), and surgery (10.7%) approaches; there was no overlap in the 95% CI between the first three and the last three management approaches, indicating a nonrandom difference.
Guideline Ranking & Disclaimer
Rank | Definition |
|---|---|
| 1 | This guideline is new and represents the best available evidence at this time. It will be reviewed on an annual basis to determine if it remains current. |
| 2 | This guideline is reviewed on an annual basis and there have been new studies published since the guideline was developed. However, the Health and Science Policy (HSP) Committee determined that these studies are not sufficient to warrant changing the guideline at this time. The information contained in this guideline provides the user with the best evidence available at the time the guideline was published. Readers are encouraged to search the current literature as a supplement to using this guideline. |
| 3 | This guideline is reviewed on an annual basis. The HSP Committee determined that new studies have been published that warrant an update of the (fill in) chapter/section of this practice guideline. The HSP Committee also determined that the remainder of the chapters/sections does not require updating and these recommendations remain current. |
| 4 | This guideline is reviewed on an annual basis. The HSP Committee determined that new data are available that are sufficient to potentially change guideline recommendations and a full revision is warranted. |
| 5 | This guideline has been reviewed on an annual basis. The HSP Committee has decided it is outdated; however, it has been retained for historical and/or educational purposes. These guidelines should be used with caution for clinical decision-making purposes. |
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