Top

Published in:

Open Access 01-12-2017 | Review

Thoracic ultrasound for pleural effusion in the intensive care unit: a narrative review from diagnosis to treatment

Authors: E. Brogi, L. Gargani, E. Bignami, F. Barbariol, A. Marra, F. Forfori, L. Vetrugno

Published in: Critical Care | Issue 1/2017

Abstract

Pleural effusion (PLEFF), mostly caused by volume overload, congestive heart failure, and pleuropulmonary infection, is a common condition in critical care patients. Thoracic ultrasound (TUS) helps clinicians not only to visualize pleural effusion, but also to distinguish between the different types. Furthermore, TUS is essential during thoracentesis and chest tube drainage as it increases safety and decreases life-threatening complications. It is crucial not only during needle or tube drainage insertion, but also to monitor the volume of the drained PLEFF. Moreover, TUS can help diagnose co-existing lung diseases, often with a higher specificity and sensitivity than chest radiography and without the need for X-ray exposure. We review data regarding the diagnosis and management of pleural effusion, paying particular attention to the impact of ultrasound. Technical data concerning thoracentesis and chest tube drainage are also provided.

Maslove DM, Chen BT, Wang H, Kuschner WG. The diagnosis and management of pleural effusions in the ICU. J Intensive Care Med. 2013;28(1):24–36.CrossRefPubMed

Graf J. Pleural effusion in the mechanically ventilated patient. Curr Opin Crit Care. 2009;15(1):10–7.CrossRefPubMed

Mattison LE, Coppage L, Alderman DF, Herlong JO, Sahn SA. Pleural effusions in the medical ICU: prevalence, causes, and clinical implications. Chest. 1997;111(4):1018–23.CrossRefPubMed

Fartoukh M, Azoulay E, Galliot R, Le Gall JR, Baud F, Chevret S, Schlemmer B. Clinically documented pleural effusions in medical ICU patients: how useful is routine thoracentesis? Chest. 2002;121(1):178–84.CrossRefPubMed

Azoulay E. Pleural effusions in the intensive care unit. Curr Opin Pulm Med. 2003;9(4):291–7.CrossRefPubMed

Goligher EC, Leis JA, Fowler RA, Pinto R, Adhikari NK, Ferguson ND. Utility and safety of draining pleural effusions in mechanically ventilated patients: a systematic review and meta-analysis. Crit Care (London, England). 2011;15(1):R46.CrossRef

Cartaxo AM, Vargas FS, Salge JM, Marcondes BF, Genofre EH, Antonangelo L, Marchi E, Teixeira LR. Improvements in the 6-min walk test and spirometry following thoracentesis for symptomatic pleural effusions. Chest. 2011;139(6):1424–9.CrossRefPubMed

Kopec SE, Conlan AA, Irwin RS. Perforation of the right ventricle: a complication of blind placement of a chest tube into the postpneumonectomy space. Chest. 1998;114(4):1213–5.CrossRefPubMed

Bozzani A, Arici V, Bellinzona G, Pirrelli S, Forni E, Odero A. Iatrogenic pulmonary artery rupture due to chest-tube insertion. Tex Heart Inst J. 2010;37(6):732–3.PubMedPubMedCentral

10.

Harris A, O'Driscoll BR, Turkington PM. Survey of major complications of intercostal chest drain insertion in the UK. Postgrad Med J. 2010;86(1012):68–72.CrossRefPubMed

11.

Yang PC, Luh KT, Chang DB, Wu HD, Yu CJ, Kuo SH. Value of sonography in determining the nature of pleural effusion: analysis of 320 cases. AJR Am J Roentgenol. 1992;159(1):29–33.CrossRefPubMed

12.

Havelock T, Teoh R, Laws D, Gleeson F. Pleural procedures and thoracic ultrasound: British Thoracic Society Pleural Disease Guideline 2010. Thorax. 2010;65 Suppl 2:ii61–76.CrossRefPubMed

13.

Lichtenstein D, Goldstein I, Mourgeon E, Cluzel P, Grenier P, Rouby JJ. Comparative diagnostic performances of auscultation, chest radiography, and lung ultrasonography in acute respiratory distress syndrome. Anesthesiology. 2004;100(1):9–15.CrossRefPubMed

14.

Fagley RE, Haney MF, Beraud AS, Comfere T, Kohl BA, Merkel MJ, Pustavoitau A, von Homeyer P, Wagner CE, Wall MH. Critical care basic ultrasound learning goals for American anesthesiology critical care trainees: recommendations from an expert group. Anesth Analg. 2015;120(5):1041–53.CrossRefPubMed

15.

Mayo PH, Beaulieu Y, Doelken P, Feller-Kopman D, Harrod C, Kaplan A, Oropello J, Vieillard-Baron A, Axler O, Lichtenstein D, et al. American College of Chest Physicians/La Societe de Reanimation de Langue Francaise statement on competence in critical care ultrasonography. Chest. 2009;135(4):1050–60.CrossRefPubMed

16.

Kataoka H, Takada S. The role of thoracic ultrasonography for evaluation of patients with decompensated chronic heart failure. J Am Coll Cardiol. 2000;35(6):1638–46.CrossRefPubMed

17.

Baldi G, Gargani L, Abramo A, D'Errico L, Caramella D, Picano E, Giunta F, Forfori F. Lung water assessment by lung ultrasonography in intensive care: a pilot study. Intensive Care Med. 2013;39(1):74–84.CrossRefPubMed

18.

Blackmore CC, Black WC, Dallas RV, Crow HC. Pleural fluid volume estimation: a chest radiograph prediction rule. Acad Radiol. 1996;3(2):103–9.CrossRefPubMed

19.

Kocijancic I, Vidmar K, Ivanovi-Herceg Z. Chest sonography versus lateral decubitus radiography in the diagnosis of small pleural effusions. J Clin Ultrasound. 2003;31(2):69–74.CrossRefPubMed

20.

Clec'h C, Simon P, Hamdi A, Hamza L, Karoubi P, Fosse JP, Gonzalez F, Vincent F, Cohen Y. Are daily routine chest radiographs useful in critically ill, mechanically ventilated patients? A randomized study. Intensive Care Med. 2008;34(2):264–70.CrossRefPubMed

21.

Zanobetti M, Poggioni C, Pini R. Can chest ultrasonography replace standard chest radiography for evaluation of acute dyspnea in the ED? Chest. 2011;139(5):1140–7.CrossRefPubMed

22.

Peris A, Tutino L, Zagli G, Batacchi S, Cianchi G, Spina R, Bonizzoli M, Migliaccio L, Perretta L, Bartolini M, et al. The use of point-of-care bedside lung ultrasound significantly reduces the number of radiographs and computed tomography scans in critically ill patients. Anesth Analg. 2010;111(3):687–92.CrossRefPubMed

23.

Rocco M, Carbone I, Morelli A, Bertoletti L, Rossi S, Vitale M, Montini L, Passariello R, Pietropaoli P. Diagnostic accuracy of bedside ultrasonography in the ICU: feasibility of detecting pulmonary effusion and lung contusion in patients on respiratory support after severe blunt thoracic trauma. Acta Anaesthesiol Scand. 2008;52(6):776–84.CrossRefPubMed

24.

Xirouchaki N, Magkanas E, Vaporidi K, Kondili E, Plataki M, Patrianakos A, Akoumianaki E, Georgopoulos D. Lung ultrasound in critically ill patients: comparison with bedside chest radiography. Intensive Care Med. 2011;37(9):1488–93.CrossRefPubMed

25.

Volpicelli G, Elbarbary M, Blaivas M, Lichtenstein DA, Mathis G, Kirkpatrick AW, Melniker L, Gargani L, Noble VE, Via G, et al. International evidence-based recommendations for point-of-care lung ultrasound. Intensive Care Med. 2012;38(4):577–91.CrossRefPubMed

26.

Sajadieh H, Afzali F, Sajadieh V, Sajadieh A. Ultrasound as an alternative to aspiration for determining the nature of pleural effusion, especially in older people. Ann N Y Acad Sci. 2004;1019:585–92.CrossRefPubMed

27.

Qureshi NR, Rahman NM, Gleeson FV. Thoracic ultrasound in the diagnosis of malignant pleural effusion. Thorax. 2009;64(2):139–43.CrossRefPubMed

28.

Menger R, Telford G, Kim P, Bergey MR, Foreman J, Sarani B, Pascual J, Reilly P, Schwab CW, Sims CA. Complications following thoracic trauma managed with tube thoracostomy. Injury. 2012;43(1):46–50.CrossRefPubMed

29.

Vignon P, Chastagner C, Berkane V, Chardac E, Francois B, Normand S, Bonnivard M, Clavel M, Pichon N, Preux PM, et al. Quantitative assessment of pleural effusion in critically ill patients by means of ultrasonography. Crit Care Med. 2005;33(8):1757–63.CrossRefPubMed

30.

Roch A, Bojan M, Michelet P, Romain F, Bregeon F, Papazian L, Auffray JP. Usefulness of ultrasonography in predicting pleural effusions > 500 mL in patients receiving mechanical ventilation. Chest. 2005;127(1):224–32.CrossRefPubMed

31.

Balik M, Plasil P, Waldauf P, Pazout J, Fric M, Otahal M, Pachl J. Ultrasound estimation of volume of pleural fluid in mechanically ventilated patients. Intensive Care Med. 2006;32(2):318–21.CrossRefPubMed

32.

Usta E, Mustafi M, Ziemer G. Ultrasound estimation of volume of postoperative pleural effusion in cardiac surgery patients. Interact Cardiovasc Thorac Surg. 2010;10(2):204–7.CrossRefPubMed

33.

Remerand F, Dellamonica J, Mao Z, Ferrari F, Bouhemad B, Jianxin Y, Arbelot C, Lu Q, Ichai C, Rouby JJ. Multiplane ultrasound approach to quantify pleural effusion at the bedside. Intensive Care Med. 2010;36(4):656–64.CrossRefPubMed

34.

Yang PC, Luh KT, Chang DB, Yu CJ, Kuo SH, Wu HD. Ultrasonographic evaluation of pulmonary consolidation. Am Rev Respir Dis. 1992;146(3):757–62.CrossRefPubMed

35.

Lichtenstein DA. Lung ultrasound in the critically ill. Ann Intensive Care. 2014;4(1):1.CrossRefPubMedPubMedCentral

36.

Lichtenstein D. Novel approaches to ultrasonography of the lung and pleural space: where are we now? Breathe. 2017;13(2):100–11.CrossRefPubMedPubMedCentral

37.

Gargani L, Volpicelli G. How I do it: lung ultrasound. Cardiovasc Ultrasound. 2014;12:25.CrossRefPubMedPubMedCentral

38.

Bouhemad B, Zhang M, Lu Q, Rouby JJ, 1. Bedside lung ultrasound in critical care practice. Crit Care (London, England). 2007;11:205.CrossRef

39.

Diacon AH, Brutsche MH, Soler M. Accuracy of pleural puncture sites: a prospective comparison of clinical examination with ultrasound. Chest. 2003;123(2):436–41.CrossRefPubMed

40.

Wrightson JM, Fysh E, Maskell NA, Lee YC. Risk reduction in pleural procedures: sonography, simulation and supervision. Curr Opin Pulm Med. 2010;16(4):340–50.CrossRefPubMed

41.

Barnes TW, Morgenthaler TI, Olson EJ, Hesley GK, Decker PA, Ryu JH. Sonographically guided thoracentesis and rate of pneumothorax. J Clin Ultrasound. 2005;33(9):442–6.CrossRefPubMed

42.

Gordon CE, Feller-Kopman D, Balk EM, Smetana GW. Pneumothorax following thoracentesis: a systematic review and meta-analysis. Arch Intern Med. 2010;170(4):332–9.CrossRefPubMed

43.

Cavanna L, Mordenti P, Berte R, Palladino MA, Biasini C, Anselmi E, Seghini P, Vecchia S, Civardi G, Di Nunzio C. Ultrasound guidance reduces pneumothorax rate and improves safety of thoracentesis in malignant pleural effusion: report on 445 consecutive patients with advanced cancer. World J Surg Oncol. 2014;12:139.CrossRefPubMedPubMedCentral

44.

Thomsen TW, DeLaPena J, Setnik GS. Videos in clinical medicine. Thoracentesis. N Engl J Med. 2006;355(15), e16.CrossRefPubMed

45.

Ko JM, Kim J, Park SA, Jin KN, Ahn MI, Kim SC, Han DH. Depth of pleural effusion in thoracentesis: comparison of lateral, posterolateral and posterior approaches in the supine position. Iran J Radiol. 2016;13(2), e20919.PubMedPubMedCentral

46.

Mayo PH, Doelken P. Pleural ultrasonography. Clin Chest Med. 2006;27(2):215–27.CrossRefPubMed

47.

Mayo PH, Goltz HR, Tafreshi M, Doelken P. Safety of ultrasound-guided thoracentesis in patients receiving mechanical ventilation. Chest. 2004;125(3):1059–62.CrossRefPubMed

48.

Dev SP, Nascimiento Jr B, Simone C, Chien V. Videos in clinical medicine. Chest-tube insertion. N Engl Econ Rev. 2007;357(15), e15.

49.

Salamonsen M, Dobeli K, McGrath D, Readdy C, Ware R, Steinke K, Fielding D. Physician-performed ultrasound can accurately screen for a vulnerable intercostal artery prior to chest drainage procedures. Respirology (Carlton, Vic). 2013;18(6):942–7.CrossRef

50.

Salamonsen M, Ellis S, Paul E, Steinke K, Fielding D. Thoracic ultrasound demonstrates variable location of the intercostal artery. Respiration. 2012;83(4):323–9.CrossRefPubMed

51.

Hew M, Rahman N, 6. Preventing intercostal vessel trauma: ultrasound to the rescue once more? Respirology (Carlton, Vic). 2013;18:891–2.CrossRef

52.

Koyanagi T, Kawaharada N, Kurimoto Y, Ito T, Baba T, Nakamura M, Watanebe A, Higami T, 1. Examination of intercostal arteries with transthoracic Doppler sonography. Echocardiography (Mount Kisco, NY). 2010;27:17–20.CrossRef

53.

Tattersall DJ, Traill ZC, Gleeson FV. Chest drains: does size matter? Clin Radiol. 2000;55(6):415–21.CrossRefPubMed

54.

Filosso PL, Sandri A, Guerrera F, Ferraris A, Marchisio F, Bora G, Costardi L, Solidoro P, Ruffini E, Oliaro A. When size matters: changing opinion in the management of pleural space-the rise of small-bore pleural catheters. J Thorac Dis. 2016;8(7):E503–10.CrossRefPubMedPubMedCentral

55.

Deneuville M. Morbidity of percutaneous tube thoracostomy in trauma patients. Eur J Cardiothorac Surg. 2002;22(5):673–8.CrossRefPubMed

56.

Liang SJ, Tu CY, Chen HJ, Chen CH, Chen W, Shih CM, Hsu WH. Application of ultrasound-guided pigtail catheter for drainage of pleural effusions in the ICU. Intensive Care Med. 2009;35(2):350–4.CrossRefPubMed

57.

Parulekar W, Di Primio G, Matzinger F, Dennie C, Bociek G. Use of small-bore vs large-bore chest tubes for treatment of malignant pleural effusions. Chest. 2001;120(1):19–25.CrossRefPubMed

58.

Horsley A, Jones L, White J, Henry M. Efficacy and complications of small-bore, wire-guided chest drains. Chest. 2006;130(6):1857–63.CrossRefPubMed

59.

Davies HE, Merchant S, McGown A, 4. A study of the complications of small bore 'Seldinger' intercostal chest drains. Respirology (Carlton, Vic). 2008;13:603–7.CrossRef

60.

Fysh ET, Smith NA, Lee YC. Optimal chest drain size: the rise of the small-bore pleural catheter. Semin Respir Crit Care Med. 2010;31(6):760–8.CrossRefPubMed

61.

Vetrugno L, Volpicelli G, Barbariol F, Toretti I, Pompei L, Forfori F, Della RG. Phantom model and scoring system to assess ability in ultrasound-guided chest drain positioning. Crit Ultrasound J. 2016;8(1):1.CrossRefPubMedPubMedCentral

Title: Thoracic ultrasound for pleural effusion in the intensive care unit: a narrative review from diagnosis to treatment
Authors: E. Brogi
L. Gargani
E. Bignami
F. Barbariol
A. Marra
F. Forfori
L. Vetrugno
Publication date: 01-12-2017
Publisher: BioMed Central
Published in: Critical Care / Issue 1/2017
Electronic ISSN: 1364-8535
DOI: https://doi.org/10.1186/s13054-017-1897-5

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Thoracic ultrasound for pleural effusion in the intensive care unit: a narrative review from diagnosis to treatment

Abstract

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 1/2017

Erratum to: Contribution of Candida biomarkers and DNA detection for the diagnosis of invasive candidiasis in ICU patients with severe abdominal conditions

Antiarrhythmic drugs in out-of-hospital cardiac arrest: is there a place for potassium chloride?

Dual inhibition of thrombin and activated factor X attenuates disseminated intravascular coagulation and protects organ function in a baboon model of severe Gram-negative sepsis

Association between continuous hyperosmolar therapy and survival in patients with traumatic brain injury – a multicentre prospective cohort study and systematic review

Erratum to: P95 B-lines on chest ultrasound predicts elevated left ventricular diastolic pressures

A randomized controlled pilot study to evaluate the effect of an enteral formulation designed to improve gastrointestinal tolerance in the critically ill patient—the SPIRIT trial