Clinically Significant Pleural Effusion in Intensive Care: A Prospective Multicenter Cohort Study

Area of Science:

• Critical Care Medicine
• Pulmonology
• Thoracic Surgery

Background:

• Clinically significant pleural effusion is common in critically ill patients.
• Optimal management strategies for pleural effusion in intensive care units (ICUs) remain unclear.
• Thoracic ultrasound is a key diagnostic tool for identifying pleural effusions.

Purpose of the Study:

• To determine the prevalence, characteristics, and outcomes of clinically significant pleural effusions in critically ill patients.
• To compare the efficacy and safety of pleural drainage versus expectant medical management.
• To assess the impact of early drainage on oxygenation and diagnostic accuracy.

Main Methods:

• A prospective, multicenter cohort study was conducted in ICUs across four teaching hospitals.
• Consecutive patients with clinically significant pleural effusions (depth ≥ 2 cm on thoracic ultrasound with adverse effects) were enrolled.
• Patients were managed with either early pleural drainage or expectant medical management.

Main Results:

• Of 7,342 screened patients, 226 (3.1%) had clinically significant pleural effusions.
• Early drainage (n=76) significantly improved oxygenation (PaO2:FiO2 ratio increased by 29.6%, p < 0.01), unlike expectant management (n=150, +7.2% increase, p = 0.44).
• Serious adverse events were similar between groups (10.5% vs 16.0%, p = 0.32), and early drainage improved diagnostic accuracy and treatment optimization.

Conclusions:

• Early pleural drainage in critically ill patients with significant effusions improves oxygenation.
• This management approach enhances diagnostic accuracy without increasing complications.
• Pleural drainage is a safe and effective intervention for managing significant pleural effusions in the ICU setting.