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Pleural effusions in the intensive care unit.

Elie Azoulay1

  • 1Service de Réanimation Médicale, Hôpital Saint-Louis et Université Paris, France. elie.azoulay@sls.ap-hop-paris.fr

Current Opinion in Pulmonary Medicine
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Summary

Pleural effusions are common in intensive care units, with ultrasonography detecting over 60%. Thoracentesis is a safe and crucial diagnostic and therapeutic procedure for critically ill patients, even on mechanical ventilation.

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Area of Science:

  • Critical Care Medicine
  • Pulmonology
  • Diagnostic Procedures

Background:

  • Pleural effusion incidence in intensive care units (ICU) ranges from 8% (physical exam) to over 60% (ultrasonography).
  • Contributing factors include fluid administration, pneumonia, heart failure, atelectasis, catheter migration, hypoalbuminemia, liver disease, and post-surgical complications.
  • Hemothorax is a significant concern in trauma patients.

Purpose of the Study:

  • To review screening methods for pleural effusions in ICU patients.
  • To assess the safety and utility of thoracentesis in mechanically ventilated patients.
  • To discuss the diagnosis and management of pleural effusions, including exudate vs. transudate differentiation and infected effusions.

Main Methods:

  • Review of literature on pleural effusions in the ICU setting.
  • Discussion of clinical parameters, diagnostic procedures, and management strategies.
  • Emphasis on the role of thoracentesis in diagnosis and treatment.

Main Results:

  • Ultrasonography significantly increases pleural effusion detection rates compared to physical examination.
  • Thoracentesis is a safe and indicated procedure for diagnosing and treating pleural effusions in ICU patients, including those on mechanical ventilation.
  • No clinical parameter can exclude pleural infection, underscoring the need for diagnostic procedures.

Conclusions:

  • Screening for pleural effusions using ultrasonography is recommended in ICU patients.
  • Thoracentesis should be performed for diagnosis and treatment unless contraindicated, even in mechanically ventilated patients.
  • Further research is needed to establish a definitive research agenda for pleural effusions in the ICU.