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Oncologic Critical Care pp 643–651Cite as

Pleural Disease: Malignant and Benign Pleural Effusions

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Abstract

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.

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Author information

Authors and Affiliations

  1. Lincoln Medical and Mental Health Center, New York, NY, USA

    María F. Landaeta

  2. Interventional Pulmonology Unit, Clínica Alemana de Santiago-Universidad del Desarrollo, Santiago, Chile

    Macarena R. Vial

  3. Servicio de Enfermedades Respiratorias, Unidad de Neumologia Intervencional, Clinica Alemana de Santiago, Vitacura, Santiago, Chile

    Macarena R. Vial

Authors
  1. María F. Landaeta
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  2. Macarena R. Vial
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Corresponding author

Correspondence to Macarena R. Vial .

Editor information

Editors and Affiliations

  1. Department of Critical Care and Respiratory Care, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Joseph L. Nates

  2. Division of Anesthesiology, Critical Care and Pain Medicine, Department of Critical Care and Respiratory Care, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Kristen J. Price

Section Editor information

  1. Critical Care Department, Universidad del Rosario Hospital Universitario Fundacion Santa Fe de, Bogota, Colombia, Colombia

    Yenny Cardenas

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Landaeta, M.F., Vial, M.R. (2020). Pleural Disease: Malignant and Benign Pleural Effusions. In: Nates, J., Price, K. (eds) Oncologic Critical Care. Springer, Cham. https://doi.org/10.1007/978-3-319-74588-6_62

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  • DOI: https://doi.org/10.1007/978-3-319-74588-6_62

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-74587-9

  • Online ISBN: 978-3-319-74588-6

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