• Tuhina Raman, Sarenthia Mcclelland, Thaddeus Bartter, and Nikhil Meena.
• Division of Pulmonary and Critical Care, Interventional Pulmonary, Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
• J Thorac Dis. 2018 Jun 1; 10 (6): 3874-3878.

BackgroundWith increased availability of techniques to address pleural effusions including medical thoracoscopy (MT) and tunneled pleural catheter (TPC), we anticipate there has been an evolution in the practice pattern. We sought to evaluate the current practice patterns in the management of exudative pleural effusion in the interventional pulmonary (IP) community.MethodsA questionnaire was developed and was disseminated to all listed American Association of Bronchology and Interventional Pulmonology (AABIP) members. Survey addressed the approach to the management of recurrent exudative pleural effusions with emphasis on the roles of Semi-rigid and rigid thoracoscopy.ResultsOf 388 members who opened the survey, 165 (43%) completed it. The majority were interventional pulmonologists representing academic and private practice in the United States (US), with approximately one third of respondents from other countries. Almost two thirds (61%) of them perform thoracoscopy. For those who do perform thoracoscopy, 93% would perform thoracoscopy for recurrent undiagnosed exudate. Equal numbers perform rigid and semi-rigid thoracoscopy and 31 (44%) perform both procedures, there was no statistically significant difference. There was a slight preference for Semi-rigid thoracoscopy although opinion was skewed slightly in favor of rigid thoracoscopy when asked about diagnostic yield. TPCs play a large role in management patterns, sometimes without and sometimes after thoracoscopy, 59% of the respondents chose a TPC alone for the management of known malignant effusion, while a 16% would combine it with MT (P value <0.0001).ConclusionsThoracoscopy is accepted as the diagnostic procedure of choice for undiagnosed exudative effusion. TPCs play a dominant role in management even when thoracoscopy is performed.

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