Evaluation of the effect of the quality and quantity of fluid drained due to pleural effusion on complications that may develop in intensive care unit

Year 2024, Volume: 6 Issue: 4, 255 - 260, 29.07.2024

Melek Doğancı

https://doi.org/10.38053/acmj.1484075

Abstract

Aims: Pleural drainage volume is very important for oxygenation and perfusion in patients with massive pleural effusion. However, there is still no clear data between the complications that may develop after pleural drainage and the optimal volume of fluid to be removed. The primary aim of this study was to evaluate the effect of the quality and quantity of pleural fluid drained due to pleural effusion in the intensive care unit (ICU) on the complications that may develop after drainage and to determine the optimal drainage volume to prevent complications. The secondary aim was to determine the risk factors affecting the development of complications after pleural effusion drainage.
Methods: A total of 176 patients who underwent pleural drainage for pleural effusion between April 1,2022 and December 31,2023 in an adult tertiary ICU were retrospectively analyzed. Demographic information, clinical follow-up information, quantity and quality of pleural effusion, laboratory values and complications were recorded and the relationship between these parameters and the amount of pleural fluid drained within 24 hours and complications were evaluated.
Results: ICU duration, ICU mortality, activated partial thromboplastin time (aPTT) and vasopressor requirement were found to be statistically significantly higher in patients with complications after pleural drainage procedure.  In multivariate logistic regression analysis, female gender (odds ratio=0.455, p=0.049) and need for vasopressors (odds ratio=2.373, p=0.034) increased the risk of complications. There was no statistically significant difference between the amount of pleural fluid drained and complications. In addition, when the optimal amount of drained fluid required to prevent complications was analyzed, a cut off value could not be given.
Conclusion: In order to reduce the risk of complications that may develop after pleural drainage, we believe that paying more attention to the position during pleural drainage in patients receiving vasopressor support and performing pleural drainage with the help of ultrasound in patients whose position cannot be changed due to hemodynamic disorder will reduce the complication rate. We think that a decrease in the complication rate will be effective in terms of both cost and efficient use of ICU beds by reducing the length of ICU stay and ICU mortality. In our study, the quality and quantity of pleural fluid drained had no effect on the complications that may develop after drainage, and further studies with a larger patient population are needed to investigate this situation.

Keywords

chest tube, complications, pleural effusion, pneumothorax, pleural volume

Ethical Statement

Ethical approval was received by the Ankara Atatürk Training and Research Hospital Ethics Committee dated 27 March 2024 and numbered 2024-BÇEK/52.

Supporting Institution

none

Thanks

none

References

• Samuelsson S, Karlin F, Ekström M. Complications of ultrasound guided very small-bore chest drains for pleural effusions of different etiology. J Thorac Dis. 2024;16(3):1866.
• Fysh ET, Smallbone P, Mattock N, et al. Clinically significant pleural effusion in intensive care: a prospective multicenter cohort study. Crit Care Explor. 2020;2(1):0070.
• Cantey EP, Walter JM, Corbridge T, Barsuk JH. Complications of thoracentesis: incidence, risk factors, and strategies for prevention. Curr Opin Pulm Med. 2016;22(4):378-385.
• Nicholson MJ, Manley C, Ahmad D. Thoracentesis for the diagnosis and management of pleural effusions: the current state of a centuries-old procedure. J Respir. 2023;3(4): 208-222.
• Treml B, Rajsic S, Diwo F, Hell T, Hochhold C. Small drainage volumes of pleural effusions are associated with complications in critically Ill patients: a retrospective analysis. J Clin Med. 2021; 10(11):2453.
• Goligher EC, Leis JA, Fowler RA, Pinto R, Adhikari NK, Ferguson ND. Utility and safety of draining pleural effusions in mechanically ventilated patients: a systematic review and meta-analysis. Crit. 2011;15:1-14.
• Roch A, Bojan M, Michelet P, et al. Usefulness of ultrasonography in predicting pleural effusions >500 ml in patients receiving mechanical ventilation. Chest. 2005;127:224-232.
• Corcoran JP, Psallidas I, Wrightson JM, Hallifax RJ, Rahman NM. Pleural procedural complications: prevention and management. J Thorac Dis. 2015;7(6):1058.
• Kıral N, Fidan A, Saraç G, Torun E, Tokmak M, Çağlayan B. Plevral efüzyonlarda sıvı miktarı ile etyolojinin ilişkisi. Solunum. 2008;10(2):97-101.
• Louw EH, Shaw JA, Koegelenberg CFN. New insights into spontaneous pneumothorax: a review. Afr J Thorac Crit Care Med. 2021;27(1):18-22.
• Nishimoto K, Fujisawa T, Yoshimura K, et al. Pneumothorax in connective tissue disease-associated interstitial lung disease. PLoS One. 2020;15(7):0235624.
• Vetrugno L, Bove T, Guadagnin GM, Orso D, Brussa A, Volpicelli G. Advances in lung ultrasound in critically ill patients. J Emerg Crit Care Med. 2019;3:1.
• Park S, Kim WY, Baek MS. Risk factors for mortality among mechanically ventilated patients requiring pleural drainage. Int J Gen Med. 2022;15:1637-1646.
• Asciak R, Bedawi EO, Bhatnagar R, et al. British thoracic society clinical statement on pleural procedures. Thorax. 2023;78:43-68.
• Gordon CE, Feller-Kopman D, Balk EM, et al. Pneumothorax following thoracentesis: a systematic review and meta-analysis. Arch Intern Med. 2010;170:332-339.
• Bateman M, Alkhatib A, John T, Parikh M, Kheir F. Pleural effusion outcomes in intensive care: analysis of a large clinical 
database. J. Intensive Care Med. 2019;35:48-54.
• Cafarotti S, Dall’Armi V, Cusumano G, et al. Small-bore wire-guided chest drains: safety, tolerability, and effectiveness in pneumothorax, malignant effusions, and pleural empyema. J Thorac Cardiovasc Surg. 2011;141(3):683-687.
• Vetrugno L, Bignami E, Orso D, et al. Utility of pleural effusion drainage in the ICU: an updated systematic review and meta-analysis. Crit. 2019;52:22-32.
• Razazi K, Thille AW, Carteaux G, 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.
• DeBiasi EM, Feller Kopman D. Anatomy and applied physiology of the pleural space. Clin Chest Med. 2021;42(4):567-576.
• Ault MJ, Rosen BT, Scher J, et al. Thoracentesis outcomes:a 12-year experience. Thorax. 2015;70:127-132.
• Feller-Kopman D, Maldonado F, Mullon JJ. Point/counterpoint: should pleural manometry be performed routinely during thoracentesis? Yes/no. Chest. 2012;141:844-850.