Management of Lung Entrapment and Trapped Lung

Diagnosis and Definition

Lung entrapment is characterized by an active pleural process, such as malignancy, causing a visceral pleural peel to form, preventing lung expansion, as defined by the European Respiratory Society 3, 4
Trapped lung occurs when the fibrous peel has arisen as a consequence of remote inflammation in the pleural space that is no longer active, with similar mechanical challenges to lung entrapment, according to the European Respiratory Society 3, 4

Indwelling pleural catheters (IPCs) are the most effective management option for both lung entrapment and trapped lung, with symptomatic improvement reported in >94% of patients, as recommended by the European Respiratory Society 1, 2
IPCs offer benefits including high symptomatic improvement rates (>94% in most studies), better effusion control rates compared to talc pleurodesis, and improved dyspnea-free exercise scores, as reported by the European Respiratory Society 2, 7
IPCs also result in shorter hospital stays compared to other interventions, with a significant reduction in morbidity, as noted by the European Respiratory Society 7, 6

Intrapleural fibrinolytic therapy may be considered in patients unsuitable for surgery, with significant loculations, or with limited life expectancy, although evidence is limited, as stated by the European Respiratory Society 7, 5
Pleuroperitoneal shunts are no longer recommended due to high complication rates and poor supporting evidence, as advised by the European Respiratory Society 7, 5

Diagnostic challenges exist, with no proven prospective methods for predicting trapped lung, and pleural manometry, M-mode ultrasonography, and symptoms during aspiration requiring further validation, as noted by the European Respiratory Society 1, 4
Complications of IPCs, such as infection, catheter blockage or displacement, and peri-catheter fluid leakage, must be monitored and managed promptly, as recommended by the European Respiratory Society 2, 6