Management of pleural effusion in mechanically ventilated critically ill patients: A systematic review and guideline

William C Chiu; Nikolay Bugaev; Kaushik Mukherjee; John J Como; George Kasotakis; Rachel S Morris; Katherine D Downton; Vanessa P Ho; Christopher W Towe; Jeannette M Capella; Bryce R H Robinson

doi:10.1016/j.amjsurg.2024.116144

Management of pleural effusion in mechanically ventilated critically ill patients: A systematic review and guideline

Am J Surg. 2024 Dec 12:240:116144. doi: 10.1016/j.amjsurg.2024.116144. Online ahead of print.

Authors

Affiliations

¹ Program in Trauma, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD, USA. Electronic address: [email protected].
² Department of Surgery, Tufts University School of Medicine, Boston, MA, USA. Electronic address: [email protected].
³ Department of Surgery, Loma Linda University Medical Center, Loma Linda, CA, USA. Electronic address: [email protected].
⁴ Department of Surgery, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA. Electronic address: [email protected].
⁵ Department of Surgery, Inova Fairfax Medical Campus, Falls Church, VA, USA. Electronic address: [email protected].
⁶ Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA. Electronic address: [email protected].
⁷ Strauss Health Sciences Library, University of Colorado Anschutz Medical Campus, Aurora, CO, USA. Electronic address: [email protected].
⁸ Department of Surgery, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA. Electronic address: [email protected].
⁹ Division of Thoracic and Esophageal Surgery, Department of Surgery, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA. Electronic address: [email protected].
¹⁰ Department of Surgery, The Iowa Clinic, Des Moines, IA, USA. Electronic address: [email protected].
¹¹ Department of Surgery, Harborview Medical Center, University of Washington School of Medicine, Seattle, WA, USA. Electronic address: [email protected].

PMID: 39708436
DOI: 10.1016/j.amjsurg.2024.116144

Abstract

Background: Mechanically ventilated critically ill patients often develop pleural effusions, which may impact lung compliance and expansion. This systematic review explores the management of pleural effusion in the critically ill population.

Methods: A comprehensive literature search was performed. Quality of evidence rating and recommendation development utilized Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology.

Results: The full search retrieved 11,965 articles for screening, of which 28 studies ultimately met inclusion criteria. There were 15 cohort studies assessing oxygenation outcome and 17 cohort studies assessing pneumothorax outcome. Patients with drainage (n = 418) had a pooled mean increase in PaO2/FiO2 ratio of 53 (P < 0.00001, 95 % CI: 43-64, I² = 0 %) compared to pre-drainage/no-drainage (n = 432). In patients with drainage, the combined incidence of pneumothorax was 124/5995 (2.1 %).

Conclusion: In mechanically ventilated critically ill adult patients with pleural effusion and hypoxia, we conditionally recommend drainage of pleural effusion to improve oxygenation. P:F ratio <200 and pleural effusion volume estimate >500 mL are conditions in which drainage would have most benefit.

Keywords: Intensive care unit; Mechanical ventilation; Oxygenation; Pleural effusion; Pneumothorax.

Publication types

Review