Pleural effusions and pneumothorax: Beyond simple plumbing

Abstract

Pleural diseases affect millions of people worldwide. Pleural infection, malignant pleural diseases and pneumothorax are common clinical challenges. A large number of recent clinical trials have provided an evidence‐based platform to evaluate conventional and novel methods to drain pleural effusions/air which reduce morbidity and unnecessary interventions. These successes have generated significant enthusiasm and raised the profile of pleural medicine as a new subspecialty. The ultimate goal of pleural research is to prevent/stop development of pleural effusions/pneumothorax. Current research studies mainly focus on the technical aspects of pleural drainage. Significant knowledge gaps exist in many aspects such as understanding of the pathobiology of the underlying pleural diseases, pharmacokinetics of pleural drug delivery, etc. Answers to these important questions are needed to move the field forward. This article collates opinions of leading experts in the field in highlighting major knowledge gaps in common pleural diseases to provoke thinking beyond pleural drainage. Recognizing the key barriers will help prioritize future research in the quest to ultimately cure (rather than just drain) these pleural conditions.

The Biological Role of Pleural Fluid PAI-1 and Sonographic Septations in Pleural Infection: Analysis of a Prospectively Collected Clinical Outcome Study

“…Several factors may be associated with treatment outcome including the rate of intrapleural inactivation of a fibrinolytic, levels of endogenous plasminogen, a higher level of active PAI-1 and extracellular DNA, and potentially the formation of biofilms (21). These may collectively, or synergistically contribute to poor outcomes in pleural infection (22).…”

Identification of Microbiome Etiology Associated With Drug Resistance in Pleural Empyema

“…It was reported that bacteria can thrive in both pleural fluid and pleural tissue (Popowicz et al, 2017). However, the invading mechanisms of microorganisms in the pleural cavity and features of the pathogenesis, such as the role of biofilm formation, have not yet been fully understood (Thomas et al, 2020). A recent study had reported that P. aeruginosa can form biofilm in an empyema model (Zhang et al, 2020).…”