PLEURAL EFFUSIONS IN THE CRITICALLY ILL PATIENT

Abstract

Pleural effusions are a frequently encountered problem affecting critically ill patients. They represent a diagnostic dilemma for treating physicians and can have detrimental physiologic effects on oxygenation and hemodynamics. Routine imaging studies and sampling techniques are often limited by the critical nature of the patient’s illness. Computerized tomography is more sensitive than plain radiographs in detecting pleural effusions and provides the clinician with additional information which may help in patient care. Diagnostic sampling of undiagnosed pleural effusions can be safely performed aided by bedside ultrasonography and plays a crucial role in determining the appropriate medical management. The appropriate therapeutic drainage method depends on the underlying etiology of the effusion, such as empyema and hemothorax, which often require large bore chest tube placement. Here we review some of the diagnostic and management considerations in the diagnosis and treatment of patients with pleural effusions in the intensive care unit.