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¿Tiene este paciente un derrame pleural exudativo? El examen clínico racional es una revisión sistemática
M Elizabeth Wilcox1, Christopher A K Y Chong2, Matthew B Stanbrook3
1Department of Medicine, University of Toronto, University Health Network, Toronto, Ontario, Canada.
JAMA
|June 19, 2014
Resumen
El diagnóstico preciso de los derrames pleurales se basa en los criterios de Light, el colesterol y los niveles de lactato deshidrogenasa (LDH). La toracentesis es generalmente segura, pero la guía de ultrasonido no reduce el riesgo de neumotórax.
Área de la Ciencia:
- Pulmonología Pulmonología.
- Medicina interna es la medicina interna de las enfermedades.
- Procedimientos de diagnóstico Procedimientos de diagnóstico
Sus antecedentes:
- La toracentesis es crucial para el diagnóstico de las causas del derrame pleural.
- Aunque generalmente es seguro, las posibles complicaciones incluyen hipoxemia, sangrado y neumotórax.
Objetivo del estudio:
- Revisar sistemáticamente la evidencia para diferenciar las efusiones transudativas y exudativas.
- Para identificar técnicas de toracentesis que minimicen los riesgos de complicaciones.
Principales métodos:
- Revisión sistemática de estudios aleatorizados y observacionales.
- Buscado en la Biblioteca Cochrane, MEDLINE y Embase hasta febrero de 2014.
- Se analizó la precisión del diagnóstico (razones de probabilidad) y las tasas de eventos adversos.
Principales resultados:
- El diagnóstico exudado es preciso con el colesterol del líquido pleural >55 mg/dL, LDH >200 U/L, o la relación colesterol/colesterol sérico >0.3.3.
- La ausencia de todos los criterios de Light hace que el diagnóstico exsudado sea poco probable (LR, 0,04).
- El neumotórax ocurrió en el 6,0% de los casos; la guía de ultrasonido no redujo este riesgo.
Conclusiones:
- Los criterios de luz, el colesterol y los niveles de LDH son claves para el diagnóstico de los exudados pleurales.
- La guía de ultrasonido para la toracentesis no disminuyó la incidencia de neumotórax.
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