Establishing a role for intra-pleural fibrinolysis in managing traumatic haemothoraces.

A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was whether there is a role in using intra-pleural fibrinolysis or thrombolysis with an agent such as streptokinase aids in resolving haemothoraces following trauma. Twenty-four papers were identified using the search below. Eight papers presented the best evidence to answer the clinical question. The author, journal, date and country of publication, patient group studied, study type, relevant outcomes, results, and study weaknesses of the papers are tabulated. We conclude that intra-pleural fibrinolytic does have a role in managing patients with unresolved haemathoraces with complete resolution clinically and radiologically in most patients in half of the studies reviewed. It may be used as an alternative to surgical intervention in certain patients, but little work has been done on comparing intra-pleural fibrinolysis directly to surgical evacuation. The choice of agent and number of administrations are variable but with a similar outcome. Few studies have compared agents. The timing of when to use these agents following the traumatic haemothorax was variable but its use was commonly reserved following 'failure' of chest drainage clinically or radiologically (so usually over a week following the original injury). The overall morbidity including bleeding complications from their use was reported as low.

Using non-steroidal anti-inflammatory drugs (NSAIDs) following pleurodesis.

A best evidence topic in cardiothoracic surgery was written according to a structured protocol. The question addressed was whether non-steroidal anti-inflammatory drugs (NSAIDs) decrease the effect of pleurodesis. Only 17 papers were identified using the search below. Three papers presented the best evidence to answer the clinical question. The author, journal, date and country of publication, patient group studied, study type, relevant outcomes, results, and study weaknesses of the papers are tabulated. We conclude that despite a limited number and type of study, there is some histopathological evidence to support the concern that NSAIDs may reduce effectiveness of pleurodesis. Until further clinical studies with appropriate outcome measures are available, NSAIDs following pleurodesis should be used with caution and probably avoided routinely.

Is talc pleurodesis safe for young patients following primary spontaneous pneumothorax?

A best evidence topic in cardiothoracic surgery was written according to a structured protocol. The question addressed was whether talc used for pleurodesis in young patients with a spontaneous pneumothorax has any long-term adverse effects. One hundred and eighty-one papers were identified using the search below. Eight papers presented the best evidence to answer the clinical question. The author, journal, date and country of publication, patient group studied, study type, relevant outcomes, results, and study weaknesses of the papers are tabulated. We conclude that talc pleurodesis in young patients with a spontaneous pneumothorax appears to have minimal long-term adverse consequences.

Does lung cancer screening with chest X-ray improve disease-free survival?

A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was whether screening an asymptomatic person with a routine chest X-ray would detect lung cancer early and, most importantly, improve that person's disease-free survival from lung cancer. Altogether 136 papers were identified using the search below. Ten papers presented the best evidence to answer the clinical question. The author, journal, date and country of publication, patient group studied, study type, relevant outcomes, results, and study weaknesses of the papers are tabulated. We conclude that despite methodological criticisms and concerns regarding biases inherent to screening studies, there is currently no evidence to support the use of chest X-ray to screen an asymptomatic person for lung cancer.

Does lung cancer screening with low-dose computerised tomography (LDCT) improve disease-free survival?

A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether screening an asymptomatic person with a low-dose computerised tomography (LDCT) would detect lung cancer early and most importantly improve that person's disease-free survival from lung cancer. Altogether 354 papers were identified using the search below. Ten papers presented the best evidence to answer the clinical question. The author, journal, date and country of publication, patient group studied, study type, relevant outcomes, results, and study weaknesses of the papers are tabulated. We conclude that the current observational and prevalence studies on the role of LDCT screening has failed to establish whether LDCT really impacts on improved disease-free survival, despite consistently higher early detection rates of lung cancer.