Management of pleural effusion in mechanically ventilated critically ill patients: A systematic review and guideline. Am J Surg 2025 Feb;240:116144
Date
12/22/2024Pubmed ID
39708436DOI
10.1016/j.amjsurg.2024.116144Scopus ID
2-s2.0-85212564256 (requires institutional sign-in at Scopus site) 1 CitationAbstract
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.
Author List
Chiu WC, Bugaev N, Mukherjee K, Como JJ, Kasotakis G, Morris RS, Downton KD, Ho VP, Towe CW, Capella JM, Robinson BRHAuthor
Rachel S. Morris MD Adjunct Associate Professor in the Surgery department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
Critical IllnessDrainage
Humans
Pleural Effusion
Pneumothorax
Practice Guidelines as Topic
Respiration, Artificial
