Utility of pleural effusion drainage in the ICU: An updated systematic review and META-analysis

Luigi Vetrugno; Elena Bignami; Daniele Orso; Maria Vargas; Giovanni M Guadagnin; Francesco Saglietti; Giuseppe Servillo; Giovanni Volpicelli; Paolo Navalesi; Tiziana Bove

doi:10.1016/j.jcrc.2019.03.007

Utility of pleural effusion drainage in the ICU: An updated systematic review and META-analysis

J Crit Care. 2019 Aug:52:22-32. doi: 10.1016/j.jcrc.2019.03.007. Epub 2019 Mar 19.

Authors

Affiliations

¹ Division of Anesthesia and Intensive Care Medicine, Department of Medicine, University of Udine, P.le S. Maria della Misericordia 15, 33100 Udine, Italy. Electronic address: luigi.vetrugno@asuiud.sanita.fvg.it.
² Anesthesiology, Critical Care and Pain Medicine Division, Department of Medicine and Surgery, University of Parma, Viale Gramsci 14, 43126 Parma, Italy.
³ Division of Anesthesia and Intensive Care Medicine, Department of Medicine, University of Udine, P.le S. Maria della Misericordia 15, 33100 Udine, Italy.
⁴ Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University, Naples, Italy.
⁵ University of Milan-Bicocca, School of Medicine and Surgery, Via Cadore 48, 20900 Monza, MB, Italy.
⁶ Department of Emergency Medicine, San Luigi Gonzaga University Hospital, Orbassano, Torino, Italy.
⁷ Anesthesia and Intensive Care, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy.

PMID: 30951925
DOI: 10.1016/j.jcrc.2019.03.007

Abstract

Purpose: The effects on the respiratory or hemodynamic function of drainage of pleural effusion on critically ill patients are not completely understood. First outcome was to evaluate the PiO₂/FiO₂ (P/F) ratio before and after pleural drainage.

Secondary outcomes: evaluation of A-a gradient, End-Expiratory lung volume (EELV), heart rate (HR), mean arterial pressure (mAP), left ventricular end-diastolic volume (LVEDV), stroke volume (SV), cardiac output (CO), ejection fraction (EF), and E/A waves ratio (E/A). A tertiary outcome: evaluation of pneumothorax and hemothorax complications.

Materials and methods: Searches were performed on MEDLINE, EMBASE, COCHRANE LIBRARY, SCOPUS and WEB OF SCIENCE databases from inception to June 2018 (PROSPERO CRD42018105794).

Results: We included 31 studies (2265 patients). Pleural drainage improved the P/F ratio (SMD: -0.668; CI: -0.947-0.389; p < .001), EELV (SMD: -0.615; CI: -1.102-0.219; p = .013), but not A-a gradient (SMD: 0.218; CI: -0.273-0.710; p = .384). HR, mAP, LVEDV, SV, CO, E/A and EF were not affected. The risks of pneumothorax (proportion: 0.008; CI: 0.002-0.014; p = .138) and hemothorax (proportion: 0.006; CI: 0.001-0.011; p = .962) were negligible.

Conclusions: Pleural effusion drainage improves oxygenation of critically ill patients. It is a safe procedure. Further studies are needed to assess the hemodynamic effects of pleural drainage.

Keywords: Critical care; Drainage; Meta-analysis; Pleural effusion.

Publication types

Meta-Analysis
Systematic Review

MeSH terms

Body Fluids
Cardiac Output
Critical Illness
Drainage / methods*
Hemodynamics
Humans
Intensive Care Units*
Pleural Effusion / physiopathology
Pleural Effusion / surgery*
Reproducibility of Results
Research Design
Stroke Volume
Tidal Volume