ATS/STR/STS Management of Malignant Pleural Effusions Guideline Summary

Design and created by Guideline Central in participation with the American Thoracic Society, Society of Thoracic Radiology, and Society of Thoracic Surgeons.

Document Overview

Document Title: Management of Malignant Pleural Effusions

Authoring Societies

American Thoracic Society

Society of Thoracic Radiology

Society of Thoracic Surgeons

Document Publication Date: Oct 3, 2018

Page Last Reviewed/Updated: May 5, 2026

Document Type: Guideline

Country of Publication: United States

Full Text Freely Available: Yes

Full Text Guideline: www.atsjournals.org/doi/full/10.1164/rccm.201807-1415ST

Source Citation: Feller-Kopman DJ et al. Management of Malignant Pleural Effusions – An Official ATS/STS/STR Clinical Practice Guideline. Am J Respir Crit Care Med 2018;198(7);839–849.

Supplemental Implementation Resources

Document Scope, Criteria, and Use Cases

Document Objectives: This document aims to provide practicing clinicians with the synthesis of latest evidence along with recommendations to improve patient centered outcomes.

Scope: Assessment and Screening, Diagnosis, Management

Diseases/Conditions (MeSH)

D010996 - Pleural Effusion

D016066 - Pleural Effusion, Malignant

D010996 - Pleural Effusion

D016066 - Pleural Effusion, Malignant

Keywords: MPE, malignant pleural effusion

Target Patient Population: Patients with a malignant pleural effusion (MPE)

Inclusion Criteria: Male, Female, Adult, Older Adult

Health Care Settings: Ambulatory, Hospital, Operating and Recovery Room

Intended Users: Nurse, Nurse Practitioner, Physician, Physician Assistant, Respiratory Therapist

Recommendation Development Processes & Methodology

PICO Questions

In Patients with Known or Suspected MPE, Should Thoracic Ultrasound Be Used to Guide Pleural Interventions?
In Patients with Known or Suspected MPE Who Are Asymptomatic, Should Pleural Drainage Be Performed?
Should the Management of Patients with Symptomatic Known or Suspected MPE Be Guided by Large-Volume Thoracentesis and Pleural Manometry?
In Patients with Symptomatic MPE with Known or Suspected Expandable Lung and No Prior Definitive Therapy, Should IPCs or Chemical Pleurodesis Be Used as First-Line Definitive Pleural Intervention for Management of Dyspnea?
In Patients with Symptomatic MPE Undergoing Talc Pleurodesis, Should Talc Poudrage or Talc Slurry Be Used?
In Patients with Symptomatic MPE with Nonexpandable Lung, Failed Pleurodesis, or Loculated Effusion, Should an IPC or Chemical Pleurodesis Be Used?
In Patients with IPC-associated Infection (Cellulitis, Tunnel Infection, or Pleural Infection), Should Medical Therapy Alone or Medical Therapy and Catheter Removal Be Used?

Supplemental Methodology Resource: Data Supplement

Number of Source Documents: 285

Includes peer/external review process?: Yes

Includes public comment process?: No

Methodologist involvement?: Yes

Patient involvement?: Yes

Includes multi-disciplinary group?: Yes

Includes systematic review?: Yes

Grades quality of strength of evidence?: Yes

Grades quality of strength of recommendation?: Yes

Discloses funding source?: Yes

Discloses conflicts of interest?: Yes

Includes benefits/harms analysis with recommendations?: Yes

Identifies study selection process?: Yes

Identifies study selection criteria?: Yes

Identifies methods used to evaluate and analyze the evidence?: Yes

Identifies key questions addressed by the systematic review?: Yes

Identifies search strategy?: Yes