Abstract
IntroductionPleural effusions are frequently drained in mechanically ventilated patients but the benefits and risks of this procedure are not well established.MethodsWe performed a literature search of multiple databases (MEDLINE, EMBASE, HEALTHSTAR, CINAHL) up to April 2010 to identify studies reporting clinical or physiological outcomes of mechanically ventilated critically ill patients who underwent drainage of pleural effusions. Studies were adjudicated for inclusion independently and in duplicate. Data on duration of ventilation and other clinical outcomes, oxygenation and lung mechanics, and adverse events were abstracted in duplicate independently.ResultsNineteen observational studies (N = 1,124) met selection criteria. The mean PaO2:FiO2 ratio improved by 18% (95% confidence interval (CI) 5% to 33%, I2 = 53.7%, five studies including 118 patients) after effusion drainage. Reported complication rates were low for pneumothorax (20 events in 14 studies including 965 patients; pooled mean 3.4%, 95% CI 1.7 to 6.5%, I2 = 52.5%) and hemothorax (4 events in 10 studies including 721 patients; pooled mean 1.6%, 95% CI 0.8 to 3.3%, I2 = 0%). The use of ultrasound guidance (either real-time or for site marking) was not associated with a statistically significant reduction in the risk of pneumothorax (OR = 0.32; 95% CI 0.08 to 1.19). Studies did not report duration of ventilation, length of stay in the intensive care unit or hospital, or mortality.ConclusionsDrainage of pleural effusions in mechanically ventilated patients appears to improve oxygenation and is safe. We found no data to either support or refute claims of beneficial effects on clinically important outcomes such as duration of ventilation or length of stay.
Highlights
Pleural effusions are frequently drained in mechanically ventilated patients but the benefits and risks of this procedure are not well established
Four studies measured physiological effects of pleural drainage [31,33-35]; seven studies assessed the safety of thoracentesis [36-42]; and three studies assessed the accuracy of ultrasonographic prediction of pleural effusion size [43-45]
Limited data suggest that pleural drainage is safe, may improve oxygenation, and under certain conditions may improve respiratory mechanics
Summary
Pleural effusions are frequently drained in mechanically ventilated patients but the benefits and risks of this procedure are not well established. Pleural effusions are common in the critically ill, occurring in over 60% of patients in some series [1,2]. The impact of pleural effusions on the clinical outcomes of critically ill patients is unclear. The presence of pleural effusion on chest radiography has been associated with a longer duration of mechanical ventilation and ICU stay, the causal relationship is. Given the uncertain benefits and risks of thoracentesis in mechanically ventilated patients, we conducted a systematic review of the literature to determine the impact of draining effusions in mechanically ventilated patients on clinical and physiologic outcomes and to ascertain resolved by consensus and consultation with a third the risk of serious procedural complications
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