Therapy for pleural effusion depends on the exact cause.
Pleural puncture (see below) is indicated to improve effusion-related symptoms such as dyspnea (shortness of breath) if larger volumes are involved. Furthermore, this is required in the presence of respiratory or cardiac decompensation following extension of the pleural effusion; pleural drainage may also be indicated (indicated).
In the presence of bilateral pleural effusion, puncture should not be performed in every case. Priority should be given to treatment of the underlying disease (e.g., heart failure/heart failure).
In pneumonia (lung inflammation) with effusion, puncture should be performed to rule out pleural empyema (accumulation of pus (empyema) within the pleura, that is, between the two pleural sheets, the pleura visceralis and the pleura parietalis).
General
- Aim for normal weight! Determination of BMI (body mass index) or body composition using electrical impedance analysis.
- Falling below the BMI lower limit (from the age of 45: 22; from the age of 55: 23; from the age of 65: 24) → Participation in a medically supervised program for the underweight.
Operative therapy
- Pleurodesis – surgical procedure in which the pulmonary pleura (visceral pleura) is joined to the pleura (parietal pleura); indication: for malignant (malignant) effusion.
- Thoracoscopy – surgical method of looking into the chest cavity and assessing the pleura (pleura), as well as inserting instruments or medications through the same or additional access points (with the involvement of the thoracic surgeon)
Conventional nonsurgical therapeutic procedures
- Pleural puncture; indications (indications for use):
- Diagnostic indication: in case of unclear diagnosis; single sampling of approx. 10-20 ml pleural fluid for further diagnosis (see below “Examination of a pleural effusion“: differentiation between exudate and transudate, etc.).
- Therapeutic indications: Dyspnea (shortness of breath) or mediastinal displacement (displacement of the mediastinum from the midline of the thorax (chest) to the left or right); to drain the effusion: single or with drainage (thoracic drainage; drainage system used to drain fluid from the thorax (chest) or pleural or mediastinal space).
Procedure: The puncture is performed on a seated patient with the upper body slightly bent forward. Under sonographic control, the puncture is placed in the posterior axillary line (imaginary line running perpendicular to the lateral chest wall) at the upper edge of the ribs. Caveat. Intercostal vessels and nerves run along the lower rib margin. If possible, do not puncture below the 9th rib, as this can lead to injury to the subdiaphragmatic organs.Possible complications: postfunctional pneumothorax/life-threatening condition in which air enters the pleural space, obstructing the expansion of one lung or both lungs (0.6-6.0%).
- Suction-irrigation drainage for pleural empyema (accumulation of pus (empyema) within the pleura).
Regular check-ups
- Regular medical checkups
