Pleural effusions on the intensive care unit; Hidden morbidity with therapeutic potential
Article first published online: 25 JAN 2013
© 2012 The Authors. Respirology © 2012 Asian Pacific Society of Respirology
Volume 18, Issue 2, pages 246–254, February 2013
How to Cite
WALDEN, A. P., JONES, Q. C., MATSA, R. and WISE, M. P. (2013), Pleural effusions on the intensive care unit; Hidden morbidity with therapeutic potential. Respirology, 18: 246–254. doi: 10.1111/j.1440-1843.2012.02279.x
- Issue published online: 25 JAN 2013
- Article first published online: 25 JAN 2013
- Accepted manuscript online: 5 OCT 2012 07:30AM EST
- Received 15 March 2012; invited to revise 17 April 2012, 3 July 2012; revised 8 June 2012, 10 July 2012; accepted 16 July 2012 (Associate Editor: Ioannis Kalomenidis).
- critically ill;
- mechanical ventilation;
- pleural effusion;
Despite 50–60% of intensive care patients demonstrating evidence of pleural effusions, there has been little emphasis placed on the role of effusions in the aetiology of weaning failure. Critical illness and mechanical ventilation lead to multiple perturbations of the normal physiological processes regulating pleural fluid homeostasis, and consequently, failure of normal pleural function occurs. Effusions can lead to deleterious effects on respiratory mechanics and gas exchange, and when extensive, may lead to haemodynamic compromise. The widespread availability of bedside ultrasound has not only facilitated earlier detection of pleural effusions but also safer fluid sampling and drainage. In the majority of patients, pleural drainage leads to improvements in lung function, with data from spontaneously breathing individuals demonstrating a consistent symptomatic improvement, while a meta-analysis in critically ill patients shows an improvement in oxygenation. The effects on respiratory mechanics are less clear, possibly reflecting heterogeneity of underlying pathology. Limited data on clinical outcome from pleural fluid drainage exist; however, it appears to be a safe procedure with a low risk of major complications. The current level of evidence would support a clinical trial to determine whether the systematic detection and drainage of pleural effusions improve clinical outcomes.