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Meta-Analysis
. 2011;15(1):R46.
doi: 10.1186/cc10009. Epub 2011 Feb 2.

Utility and safety of draining pleural effusions in mechanically ventilated patients: a systematic review and meta-analysis

Ewan C Goligher  1 , Jerome A Leis, Robert A Fowler, Ruxandra Pinto, Neill K J Adhikari, Niall D Ferguson
Affiliations
Meta-Analysis

Utility and safety of draining pleural effusions in mechanically ventilated patients: a systematic review and meta-analysis

Ewan C Goligher et al. Crit Care. 2011.

Abstract

Introduction: Pleural effusions are frequently drained in mechanically ventilated patients but the benefits and risks of this procedure are not well established.

Methods: We performed a literature search of multiple databases (MEDLINE, EMBASE, HEALTHSTAR, CINAHL) up to April 2010 to identify studies reporting clinical or physiological outcomes of mechanically ventilated critically ill patients who underwent drainage of pleural effusions. Studies were adjudicated for inclusion independently and in duplicate. Data on duration of ventilation and other clinical outcomes, oxygenation and lung mechanics, and adverse events were abstracted in duplicate independently.

Results: Nineteen observational studies (N = 1,124) met selection criteria. The mean PaO2:FiO2 ratio improved by 18% (95% confidence interval (CI) 5% to 33%, I2 = 53.7%, five studies including 118 patients) after effusion drainage. Reported complication rates were low for pneumothorax (20 events in 14 studies including 965 patients; pooled mean 3.4%, 95% CI 1.7 to 6.5%, I2 = 52.5%) and hemothorax (4 events in 10 studies including 721 patients; pooled mean 1.6%, 95% CI 0.8 to 3.3%, I2 = 0%). The use of ultrasound guidance (either real-time or for site marking) was not associated with a statistically significant reduction in the risk of pneumothorax (OR = 0.32; 95% CI 0.08 to 1.19). Studies did not report duration of ventilation, length of stay in the intensive care unit or hospital, or mortality.

Conclusions: Drainage of pleural effusions in mechanically ventilated patients appears to improve oxygenation and is safe. We found no data to either support or refute claims of beneficial effects on clinically important outcomes such as duration of ventilation or length of stay.

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Figures

Figure 1
Figure 1
Summary of the study selection process.
Figure 2
Figure 2
Forest plot of meta-analysis of studies reporting change in oxygenation after pleural drainage. PaO2:FiO2 ratios before and after thoracentesis analyzed by (a) relative mean difference (ratio of means) and (b) absolute mean difference.
Figure 3
Figure 3
Forest plot of meta-analysis of studies reporting the rate of pneumothorax after pleural drainage.
Figure 4
Figure 4
Forest plot of meta-analysis of studies reporting the rate of hemothorax after pleural drainage.
See this image and copyright information in PMC

Comment in

References

    1. Azoulay E, Fartoukh M, Similowski T, Galliot R, Soufir L, Le Gall JR, Chevret S, Schlemmer B. Routine exploratory thoracentesis in ICU patients with pleural effusions: results of a French questionnaire study. J Crit Care. 2001;16:98–101. doi: 10.1053/jcrc.2001.28784. - DOI - PubMed
    1. Mattison LE, Coppage L, Alderman DF, Herlong JO, Sahn SA. Pleural effusions in the medical ICU: prevalence, causes, and clinical implications. Chest. 1997;111:1018–1023. doi: 10.1378/chest.111.4.1018. - DOI - PubMed
    1. Graf J. Pleural effusion in the mechanically ventilated patient. Curr Opin Crit Care. 2009;15:10–17. doi: 10.1097/MCC.0b013e3283220e4a. - DOI - PubMed
    1. Fartoukh M, Azoulay E, Galliot R, Le Gall JR, Baud F, Chevret S, Schlemmer B. Clinically documented pleural effusions in medical ICU patients: how useful is routine thoracentesis? Chest. 2002;121:178–184. doi: 10.1378/chest.121.1.178. - DOI - PubMed
    1. Soni N, Williams P. Positive pressure ventilation: what is the real cost? Br J Anaesth. 2008;101:446–457. doi: 10.1093/bja/aen240. - DOI - PubMed

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