Pleural Disease: Malignant and Benign Pleural Effusions
Pleural effusion is a common problem in intensive care unit (ICU) patients. Proper diagnosis involves three steps: confirmation of the effusion with imaging studies, classification as transudates or exudates and identifying the underlying cause. Imaging studies such as chest X-ray, ultrasound, and CT scan are useful to confirm the diagnosis and may also suggest the underlying cause. Ultrasound is particularly helpful in the ICU setting due to its portability and ability to characterize the effusion and guide pleural procedures. If an effusion is clinically significant or the diagnosis is unknown, then drainage and fluid analysis are essential. Mechanical ventilation is not associated with increased complications of pleural drainage and can be safely performed if indicated. Drainage also has a therapeutic objective, and it is mandatory and urgent if an infection is suspected but also indicated in patients with large effusions, a noncompliant chest wall, or severe respiratory failure requiring higher positive end-expiratory pressures (PEEP). In patients with a suspected malignant effusion, effusion will recur, and a definitive treatment may be considered if the patient survives the ICU.
KeywordsPleural effusion Malignancy Exudate Transudate Empyema Chest tube Ultrasound Thoracentesis Pleurodesis Mesothelioma Indwelling pleural catheter
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