A major part of treatment is usually directed to the underlying cause of the build-up of fluid between the lung and the chest wall (pleural effusion). For example, medicines called antibiotics for lung infection (pneumonia), chemotherapy or radiotherapy for cancers, etc. Therefore, treatment can vary greatly, depending on the cause of the effusion. If the underlying cause can be successfully treated then there is a good chance that the pleural effusion will go away for good. If the underlying cause cannot be treated, or can only be partially treated, the effusion may return if it is cleared (drained).
Pleural fluid for pH testing should be collected anaerobically in a heparinized syringe and measured in a blood-gas machine. 3 Frank pus should not be sent for pH determination because thick, purulent fluid may clog the blood-gas machine. A low pleural fluid pH value has prognostic and therapeutic implications for patients with parapneumonic and malignant pleural effusions. A pH value less than in a patient with a parapneumonic effusion indicates the need to drain the fluid. 14 , 15 In a patient with malignant pleural effusion, a pleural fluid pH value less than is associated with a shorter survival and poorer response to chemical pleurodesis. 1 When a pleural fluid pH value is not available, a pleural fluid glucose concentration less than 60 mg per dL can be used to identify complicated parapneumonic effusions. 14
Therapeutic aspiration may be sufficient; larger effusions may require insertion of an intercostal drain (either pigtail or surgical). When managing these chest tubes, it is important to make sure the chest tubes do not become occluded or clogged. A clogged chest tube in the setting of continued production of fluid will result in residual fluid left behind when the chest tube is removed. This fluid can lead to complications such as hypoxia due to lung collapse from the fluid, or fibrothorax if scarring occurs. Repeated effusions may require chemical ( talc , bleomycin , tetracycline / doxycycline ), or surgical pleurodesis , in which the two pleural surfaces are scarred to each other so that no fluid can accumulate between them. This is a surgical procedure that involves inserting a chest tube, then either mechanically abrading the pleura or inserting the chemicals to induce a scar. This requires the chest tube to stay in until the fluid drainage stops. This can take days to weeks and can require prolonged hospitalizations. If the chest tube becomes clogged, fluid will be left behind and the pleurodesis will fail.