Guidelines For Adult Pleural Fluid Effusion In Critical Care

Abstract

Objective: Chest drainage is a very common procedure in critical care. It is performed by practitioners from various specialties in a wide range of clinical settings. Liquid pleural effusions are the most frequent indication for chest drainage. However, practices regarding chest tube insertion, monitoring, and removal vary considerably between institutions. The objective of these recommendations is to provide guidance for the optimal management of pleural effusion (excluding purulent pleurisy, haemothorax, and malignant pleural effusion) in adult critical care patients.

Development: Fifteen experts from the French Society of Anaesthesia and Intensive Care Medicine (SFAR), the French Society of Thoracic and Cardiovascular Surgery (SFCTCV), the French Language Pulmonology Society (SPLF), and the French Society of Emergency Medicine (SFMU) were convened. All experts declared their conflicts of interest at the beginning of the guideline development process. This process was conducted independently and without any industry funding. The authors followed the GRADE methodology (Grading of Recommendations Assessment, Development and Evaluation) to assess the level of evidence in the scientific literature.

Methods: Four thematic areas were defined: (1) diagnosis and consequences of pleural effusions, (2) procedure for chest tube placement, (3) monitoring the efficacy and complications of pleural drainage, (4) chest tube removal procedure. For each area, the recommendations aimed to answer a series of questions formulated according to the PICO model (Population, Intervention, Comparison, Outcome). An extensive literature review was performed and analysed according to the GRADE methodology. Recommendations were then formulated using the GRADE approach and submitted to a vote by all experts using the GRADE Grid method.

Results: A total of 25 recommendations regarding the drainage of pleural effusion in adult critical care patients were formulated by the expert panel from SFAR, SFCTCV, SPLF, and SFMU. After four rounds of voting, strong agreement was reached for all 25 recommendations. For three additional questions, no recommendation could be formulated.

Conclusion: Strong expert consensus was reached to provide recommendations for optimising the management of pleural effusion drainage in adult critical care patients.

Keywords: Chest tube; Critical care; Drainage; Pleural effusion; Thoracentesis.