Pleural Effusion Outcomes in Intensive Care: Analysis of a Large Clinical Database

Abstract

Background: Pleural effusions are common in critically ill patients. However, the management of pleural fluid on relevant clinical outcomes is poorly studied. We evaluated the impact of pleural effusion in the intensive care unit (ICU). Methods: A large observational ICU database Multiparameter Intelligent Monitoring in Intensive Care III was utilized. Analyses used matched patients with the same admission diagnosis, age, gender, and disease severity. Results: Of 50 765, 3897 (7.7%) of critically ill adult patients had pleural effusions. Compared to patients without effusion, patients with effusion had higher in-hospital (38.7% vs 31.3%, P < .0001), 1-month (43.1% vs 36.1%, P < .0001), 6-month (63.6% vs 55.7%, P < .0001), and 1-year mortality (73.8% vs 66.1%, P < .0001), as well as increased length of hospital stay (17.6 vs 12.7 days, P < .0001), ICU stay (7.3 vs 5.1 days, P < .0001), need for mechanical ventilation (63.1% vs 55.7%, P < .0001), and duration of mechanical ventilation (8.7 vs 6.3 days, P < .0001). A total of 1503 patients (38.6%) underwent pleural fluid drainage. Patients in the drainage group had higher in-hospital (43.9% vs 35.4%, P = .0002), 1-month (47.7% vs 39.7%, P = .0005), 6-month (67.1% vs 61.8%, P = .0161), and 1-year mortality (77.1% vs 72.1%, P = .0147), as well as increased lengths of hospital stay (22.1 vs 16.0 days, P < .0001), ICU stay (9.2d vs 6.4 days, P < .0001), and duration of mechanical ventilation (11.7 vs 7.1 days, P < .0001). Conclusions: The presence of a pleural effusion was associated with increased mortality in critically ill patients regardless of disease severity. Drainage of pleural effusion was associated with worse outcomes in a large, heterogeneous cohort of ICU patients.

Small Drainage Volumes of Pleural Effusions Are Associated with Complications in Critically Ill Patients: A Retrospective Analysis

“…More recently, a French multicentre trial observed a higher rate of failed spontaneous breathing trials, fewer ventilator-free days at 1 month, and a nearly doubled ICU mortality in 249 patients with moderate-to-large pleural effusion [ 23 ]. This is in line with a retrospective analysis which found pleural effusions in nearly 4000 critically ill patients to be associated with increased mortality, draining these effusions increased mortality even more [ 11 ]. On the other hand, drainage may aid in establishing a diagnosis and thus leading to therapy [ 24 ].…”

“…Recently, the largest retrospective analysis of more than 50,000 ICU patients reported an in-hospital mortality as high as 35% in 3897 patients with pleural effusions. Furthermore, mortality increased to 43.9% after pleural drainage in 1503 patients [ 11 ].…”

“…The most prevalent causes are volume overload, congestive heart failure, pleuro-pulmonary infections, atelectasis and cardiothoracic or major abdominal surgery [ 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 ]. Based on the method of detection, either using chest radiography or thoracic ultrasound, respectively, the described incidence of pleura effusion in critically ill patients ranges from 7.7% [ 11 ] to 62% [ 10 ].…”

Risk Factors for Mortality Among Mechanically Ventilated Patients Requiring Pleural Drainage

“…2 Furthermore, among critically ill patients, patients with pleural effusions had a higher rate of in-hospital mortality than patients without effusions (38.7% vs 31.3%). 2 Pleural fluid accumulation occurs when there is an imbalance in fluid production and drainage, which can be aggravated by mechanical ventilation (MV). 3 The increase in pleural fluid leads to restrictive ventilatory defects that can cause hypoxemia, [3][4][5][6] and is associated with various hemodynamic parameters.…”

Medical thoracoscopy in intensive care unit

“…The presence of pleural effusion in critically ill patients is common (7.7%) and is associated with increased mortality, ICU and hospital stay, as well as need and duration of mechanical ventilation, regardless of disease severity in a large cohorts of ICU database (15). Recently, MT has been utilized in management for critically ill patients in the ICU with undiagnosed exudative pleural effusion (11).…”