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Critical Care
Published in: Critical Care 1/2011

Open Access 01-02-2011 | Research

Utility and safety of draining pleural effusions in mechanically ventilated patients: a systematic review and meta-analysis

Authors: Ewan C Goligher, Jerome A Leis, Robert A Fowler, Ruxandra Pinto, Neill KJ Adhikari, Niall D Ferguson

Published in: Critical Care | Issue 1/2011

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Abstract

Introduction

Pleural effusions are frequently drained in mechanically ventilated patients but the benefits and risks of this procedure are not well established.

Methods

We performed a literature search of multiple databases (MEDLINE, EMBASE, HEALTHSTAR, CINAHL) up to April 2010 to identify studies reporting clinical or physiological outcomes of mechanically ventilated critically ill patients who underwent drainage of pleural effusions. Studies were adjudicated for inclusion independently and in duplicate. Data on duration of ventilation and other clinical outcomes, oxygenation and lung mechanics, and adverse events were abstracted in duplicate independently.

Results

Nineteen observational studies (N = 1,124) met selection criteria. The mean PaO2:FiO2 ratio improved by 18% (95% confidence interval (CI) 5% to 33%, I 2 = 53.7%, five studies including 118 patients) after effusion drainage. Reported complication rates were low for pneumothorax (20 events in 14 studies including 965 patients; pooled mean 3.4%, 95% CI 1.7 to 6.5%, I 2 = 52.5%) and hemothorax (4 events in 10 studies including 721 patients; pooled mean 1.6%, 95% CI 0.8 to 3.3%, I 2 = 0%). The use of ultrasound guidance (either real-time or for site marking) was not associated with a statistically significant reduction in the risk of pneumothorax (OR = 0.32; 95% CI 0.08 to 1.19). Studies did not report duration of ventilation, length of stay in the intensive care unit or hospital, or mortality.

Conclusions

Drainage of pleural effusions in mechanically ventilated patients appears to improve oxygenation and is safe. We found no data to either support or refute claims of beneficial effects on clinically important outcomes such as duration of ventilation or length of stay.
Appendix
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Metadata
Title
Utility and safety of draining pleural effusions in mechanically ventilated patients: a systematic review and meta-analysis
Authors
Ewan C Goligher
Jerome A Leis
Robert A Fowler
Ruxandra Pinto
Neill KJ Adhikari
Niall D Ferguson
Publication date
01-02-2011
Publisher
BioMed Central
Published in
Critical Care / Issue 1/2011
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/cc10009

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