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Updated: Aug 9, 2026
International Expert Consensus and Recommendations for Neonatal Pneumothorax Ultrasound Diagnosis and Ultrasound-guided Thoracentesis Procedure
Published on: March 12, 2020
Routine exploratory thoracentesis in ICU patients with pleural effusions: results of a French questionnaire study
E Azoulay1, M Fartoukh, T Similowski
1Medical Intensive Care Unit, Saint Louis Hospital, Paris, France.
Insights
Intensivists hold varied opinions on managing pleural effusions in intensive care units (ICUs). Divergent beliefs about exploratory thoracentesis highlight the need for clear guidelines and further research on effusion epidemiology in critically ill patients.
Area of Science:
- Critical Care Medicine
- Pulmonology
- Thoracic Surgery
Background:
- Pleural effusions are common in intensive care unit (ICU) patients.
- Management strategies and diagnostic approaches for pleural effusions in the ICU lack standardized guidelines.
- Understanding intensivists' perspectives is crucial for improving patient care.
Purpose of the Study:
- To survey intensivists' opinions on the incidence, diagnosis, and management of pleural effusions in ICU settings.
- To explore the role and perceived utility of exploratory thoracentesis in critically ill patients with pleural effusions.
Main Methods:
- A questionnaire was distributed to 1,032 intensivists affiliated with the French Society of Critical Care.
- Response rate was 41.7%, with 431 questionnaires returned for analysis.
Main Results:
- Respondents estimated pleural effusion incidence at 22.19%.
- 37% believed thoracentesis could determine effusion cause, while 17% felt results would alter therapy.
- Physicians routinely performing thoracentesis (15%) more frequently attributed effusions to infection and viewed the procedure as diagnostic, therapeutic, and noninvasive.
Conclusions:
- Intensivists exhibit diverse views on pleural effusions and thoracentesis.
- Lack of precise guidelines contributes to these divergent opinions.
- Further studies are needed to clarify effusion epidemiology and causes in ICU patients.
Purpose:
The purpose of this study was to report the opinions of intensivists regarding pleural effusions in patients in the intensive care unit (ICU).
Materials And Methods:
Questionnaires were sent to 1,032 intensivists, who were members of the French Society of Critical Care.
Results:
Four hundred thirty-one questionnaires (41.7%) were returned. Overall, the respondents' estimated the incidence of pleural effusion in ICU patients to be 22.19 +/- 17%, whereas 37 +/- 27% considered that exploratory thoracentesis was likely to determine the cause of the effusion, and 17.36 +/- 16% considered that its results were likely to result in a change in their therapeutic attitude. Sixty-five (15%) physicians, chiefly pulmonologists, performed exploratory thoracentesis routinely (Group 1). Compared with those who did not perform routine thoracentesis (Group 2), they ascribed a higher proportion of pleural effusions to infection (31.3% vs. 13.5%) and were more likely to consider that exploratory thoracentesis had a diagnostic and therapeutic contribution (51.2% vs. 34% and 23% vs. 16%, respectively). In addition to the respiratory medicine subspecialty, the practice of routine exploratory thoracentesis was significantly related to seniority, to the frequency of the suspicion of an infectious cause in the physician's practice, and to his or her appreciation of the risks associated with exploratory thoracentesis. Physicians from Group 1 were also more likely to describe exploratory thoracentesis as a noninvasive procedure.
Conclusions:
The beliefs and attitudes of intensivists regarding pleural effusions and exploratory thoracentesis are divergent. This may be due to the lack of precise guidelines on the topic and prompt the design of further studies to establish precisely the epidemiology and causes of pleural effusions in ICU patients.
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