Patient handout

Pleural Effusion

PRODUCTION

1. Your condition

This handout is for pleural effusion. Your care team identified this based on: dyspnea, pleuritic chest pain, dull cough (bts 2023 roberts).

Other reasons your team may use this plan: pleural effusion on cxr / lung ultrasound / ct (bts 2023); diminished breath sounds, dullness on percussion, reduced tactile fremitus (bts 2023); known hf / cirrhosis / malignancy with new effusion (bts 2023).

2. Your medications

Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.

Medication	Starting dose	How	When	What it does
furosemide	40 mg IV/PO daily-BID (titrate), or 20 mg IV bolus + 5-10 mg/h infusion	IV/PO	daily-BID titrated to response	Treat HF cause; UOP target 1-2 L/d net negative (BTS 2023; cardio.acute-hf.core.v1 GDMT)
spironolactone	100 mg PO daily (cirrhosis, 100:40 ratio with furosemide); 25-50 mg PO daily (HF)	PO	daily	Cirrhotic hepatic hydrothorax + HF — synergistic (AASLD 2021; gi.cirrhosis.core.v1)
albumin human 25%	25 g IV after large-volume thoracentesis (>1.5 L)	IV	single dose post-procedure	Reduces post-paracentesis circulatory dysfunction; extrapolated to hepatic hydrothorax (AASLD 2021)

Plan: BTS 2023 + ATS/STS/STR 2018 — drainage strategy + substrate-directed therapy

3. When to call your provider

Contact your care team if any of the following happen:

Pleural-space infection on IPC → admit, broaden antibiotics, consider removal (BTS 2023)
Drain failure / blockage → admission for catheter exchange (BTS 2023)
New respiratory failure → ED (BTS 2023)

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

Frank pus on aspirate OR pleural fluid pH <7.20 OR positive Gram stain/culture OR loculation on US
RAPID score high-risk band (5-7 points) — 3-month mortality 29.3% (PILOT Corcoran 2020 PMID 32675200)
Large effusion (≥hemithorax) with hypoxic respiratory failure or mediastinal shift
Pleural infection with septic shock (vasopressor) or organ dysfunction(life-threatening)
Initial chest tube drainage >1500 mL OR continued >200 mL/h × 4 h OR hemodynamic instability(life-threatening)
Cirrhotic transudative effusion (usually right-sided) refractory to diuretics + Na restriction

5. Follow-up

Outpatient IPC management (3×/week drainage, taper for spontaneous pleurodesis ~46% by 70 d on AMPLE), oncology re-imaging, HF/cirrhosis substrate optimisation, repeat thoracentesis if recurrent, asbestos counselling + smoking cessation

6. Sources

Guideline: BTS 2023 Guideline for Pleural Disease (Roberts) + ATS/STS/STR 2018 MPE Management (Feller-Kopman)