Pleural Effusions in Critically Ill Patients

Abstract

Pleural effusions (PEs) are common in critically ill patients mainly as a consequence of severe cardiopulmonary disorders frequently encountered in these patients. Their impact on the pathophysiology of acute respiratory failure remains unknown. They are usually small and uncomplicated transudates that are easily overlooked on a supine portable chest X-ray and do not require drainage or infectious exudates that always require thoracocentesis. The diagnosis of PEs in critically ill patients has been revolutionized with the advent of chest ultrasound allowing easy bedside quantification of pleural fluid and making thoracocentesis a safe procedure especially in high-risk patients on mechanical ventilation. CT provides a much more accurate evaluation of the size and location of PEs and is extremely helpful in the guidance of catheters into loculated fluid collections. Hemothorax in critically ill patients is usually related to trauma or surgical interventions and requires early drainage and possibly surgical exploration.

Clinical Utility of Ultrasonographic Detection of Pleural Effusion for Evaluation of Heart Failure Patients

“…Many other studies have also confirmed the superiority of chest ultrasound for detection of small pleural effusion compared to simple chest radiographic technique (Gryminski et al, 1976;Kohan et al, 1986;Lipscomb et al, 1981;Yu et al, 1992;Zanobetti et al, 2011). Thus, the diagnosis of pleural effusions in critically ill patients has been revolutionized with the advent of chest ultrasound allowing easy bedside quantification of pleural fluid and making thoracentesis a safe procedure (Pneumatikos & Bouros, 2008 …”

Matrix Metalloproteinase Levels in the Differentiation of Parapneumonic Pleural Effusions

“…Finally, empyema was defined as a condition in which the diagnostic thoracocentesis yielded gross pus, or a positive Gram stain or bacterial culture of the pleural effusion. It has to be stressed that the identification of an empyema led in all cases to the insertion of a thoracic tube [30]. …”

Mechanisms of Pleural Involvement in Orphan Diseases

“…Hydrostatic pressure elevations can also increase filtration from the pleural membrane microvessels [2]. Most of the PEs accompanying systemic autoimmune disorders are exudative and lymphocytic [3]. However, many patients could have concomitant diseases, making the discrimination of an exudative or transudative disease difficult [4].…”