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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.

Keywords

pleural effusion critical care intensive care units drainage thoracentesis transudates exudates mechanical ventilation hospital mortality length of stay

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References

Feller-Kopman

Light

. Pleural disease. N Engl J Med. 2018;378(8):740–751.

Mattison

Coppage

Alderman

Herlong

Sahn

SA.

Pleural effusions in the medical ICU: prevalence, causes, and clinical implications. Chest. 1997;111(4):1018–1023.

Brogi

Gargani

Bignami

, et al. Thoracic ultrasound for pleural effusion in the intensive care unit: a narrative review from diagnosis to treatment. Crit Care. 2017;21(1):325.

Fartoukh

Azoulay

Galliot

, et al.

Clinically documented pleural effusions in medical ICU patients: how useful is routine thoracentesis?

Chest. 2002;121(1):178–184.

Maslove

Chen

Wang

Kuschner

. The diagnosis and management of pleural effusions in the ICU. J Intensive Care Med. 2013;28(1):24–36.

Walden

Jones

Matsa

Wise

. Pleural effusions on the intensive care unit; hidden morbidity with therapeutic potential. Respirology. 2013;18(2):246–254.

Brims

Davies

Elia

Griffiths

. The effects of pleural fluid drainage on respiratory function in mechanically ventilated patients after cardiac surgery. BMJ Open Respir Res. 2015;2(1):e000080.

Chen

Chung

Hsiao

Chang

. Pleural space elastance and changes in oxygenation after therapeutic thoracentesis in ventilated patients with heart failure and transudative pleural effusions. Respirology. 2010;15(6):1001–1008.

Razazi

Boissier

Neuville

, et al. Pleural effusion during weaning from mechanical ventilation: a prospective observational multicenter study. Ann Intensive Care. 2018;8(1):103.

10.

Dres

Roux

Pham

, et al. Prevalence and impact on weaning of pleural effusion at the time of liberation from mechanical ventilation: a multicenter prospective observational study. Anesthesiology. 2017;126(6):1107–1115.

11.

Goligher

Leis

Fowler

Pinto

Adhikari

Ferguson

. Utility and safety of draining pleural effusions in mechanically ventilated patients: a systematic review and meta-analysis. Crit Care. 2011;15(1):R46.

12.

Umbrello

Mistraletti

Galimberti

Piva

Cozzi

Formenti

. Drainage of pleural effusion improves diaphragmatic function in mechanically ventilated patients. Crit Care Resusc. 2017;19(1):64–70.

13.

Razazi

Thille

Carteaux

, et al. Effects of pleural effusion drainage on oxygenation, respiratory mechanics, and hemodynamics in mechanically ventilated patients. Ann Am Thorac Soc. 2014;11(7):1018–1024.

14.

Walden

Garrard

Salmon

. Sustained effects of thoracocentesis on oxygenation in mechanically ventilated patients. Respirology. 2010;15(6):986–992.

15.

Roch

Bojan

Michelet

, et al. Usefulness of ultrasonography in predicting pleural effusions > 500 ml in patients receiving mechanical ventilation. Chest. 2005;127(1):224–232.

16.

Johnson

Pollard

Shen

, et al. MIMIC-III, a freely accessible critical care database. Sci Data. 2016;3:16003.

17.

Raith

Udy

Bailey

, et al. Prognostic accuracy of the SOFA score, SIRS criteria, and qSOFA score for in-hospital mortality among adults with suspected infection admitted to the intensive care unit. JAMA. 2017;317(3):290–300.

18.

Granholm

Moller

Krag

Perner

Hjortrup

PB.

Predictive performance of the Simplified Acute Physiology Score (SAPS) II and the Initial Sequential Organ Failure Assessment (SOFA) Score in acutely ill intensive care patients: post-hoc analyses of the SUP-ICU inception cohort study. PLoS One. 2016;11(12):e0168948.

19.

Austin

Wong

Uzzo

Beck

JR.

Egleston

. Why summary comorbidity measures such as the Charlson Comorbidity Index and Elixhauser Score work. Med Care. 2015;53(9):e65–e72.

20.

Deyo

Cherkin

Ciol

. Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. J Clin Epidemiol. 1992;45(6):613–619.

21.

Quan

Sundararajan

Halfon

, et al. Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data. Med Care. 2005;43(11):1130–1139.

22.

Wilcox

Chong

Stanbrook

Tricco

Wong

Straus

. Does this patient have an exudative pleural effusion? The rational clinical examination systematic review. JAMA. 2014;311(23):2422–2431.

23.

Roth

O’Meara

Cragun

. The serum-effusion albumin gradient in the evaluation of pleural effusions. Chest. 1990;98(3):546–549.

24.

Romero-Candeira

Fernandez

Martin

Sanchez-Paya

Hernandez

. Influence of diuretics on the concentration of proteins and other components of pleural transudates in patients with heart failure. Am J Med. 2001;110(9):681–686.

25.

DeBiasi

Puchalski

Pleural effusions as markers of mortality and disease severity: a state-of-the-art review. Curr Opini Pulmo Med. 2015;46(2):495–502.

26.

DeBiasi

Pisani

Murphy

, et al. Mortality among patients with pleural effusion undergoing thoracentesis. Eur Respir J. 2015;46(2):495–502.

27.

Walker

Morley

Stadon

, et al. Nonmalignant pleural effusions: a prospective study of 356 consecutive unselected patients. Chest. 2017;151(5):1099–1105.

28.

Goligher

Ferguson

. Utility of draining pleural effusions in mechanically ventilated patients. Curr Opini Pulm Med. 2012;18(4):359–365.

29.

Sanchez-Pinto

Luo

Churpek

. Big data and data science in critical care. Chest. 2018;154(5):1239–1248.

30.

Hsu

Tseng

. Comparison of treatment of hepatic hydrothorax with catheter drainage versus serial thoracentesis. Curr Opini Pulm Med. 2018;24(4):392–397.

31.

Ridha

Al-Abboodi

Fasullo

The outcome of thoracentesis versus chest tube placement for hepatic hydrothorax in patients with cirrhosis: a nationwide analysis of the national inpatient sample. Gastroenterol Res Pract. 2017;2017:5872068.

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