Chest tube drainage of transudative pleural effusions hastens liberation from mechanical ventilation.
BACKGROUND
Pleural effusions occur frequently in patients requiring mechanical ventilatory support. Treatment of the precipitating cause and resolution of the pleural effusion may take considerable time. We retrospectively studied the effect of chest tube drainage of transudative pleural effusions on the liberation of patients from mechanical ventilatory support.


METHODS
Patients in the medical ICU (MICU) at Maimonides Medical Center between January 1, 2009, and October 31, 2009, requiring mechanical ventilatory support with a transudative pleural effusion, were studied retrospectively. They were divided into two groups: standard care and standard care plus chest tube drainage. Chest tubes were placed under ultrasound guidance by trained intensivists. Duration of mechanical ventilatory support was the primary end point. Secondary end points included measures of oxygenation, amount of fluid drained, and complications associated with the chest tube.


RESULTS
A total of 168 patients were studied; 88 were treated with standard care and 80 underwent chest tube drainage. Total duration of mechanical ventilatory support was significantly shorter for patients who had chest tube drainage: 3.8±0.5 days vs 6.5±1.1 days for the standard group (P=.03). No differences in oxygenation were noted between the two groups. The average amount of fluid drained was 1,220 mL. No significant complications were caused by chest tube drainage.


CONCLUSIONS
Chest tube drainage of transudative pleural effusions resulted in more rapid liberation from mechanical ventilatory support. It is a very safe procedure when performed under ultrasound guidance by experienced personnel.


BACKGROUND
ClinicalTrials.gov; Identifier: NCT0114285; URL: www.clinicaltrials.gov.
Kupfer
Yizhak
Y
Pulmonary and Critical Care Medicine, Maimonides Medical Center, Brooklyn, NY.
Seneviratne
Chanaka
C
Pulmonary and Critical Care Medicine, Maimonides Medical Center, Brooklyn, NY.
Chawla
Kabu
K
Pulmonary and Critical Care Medicine, Maimonides Medical Center, Brooklyn, NY.
Ramachandran
Kavan
K
Pulmonary and Critical Care Medicine, Maimonides Medical Center, Brooklyn, NY.
Tessler
Sidney
S
Pulmonary and Critical Care Medicine, Maimonides Medical Center, Brooklyn, NY. Electronic address: stessler@maimonidesmed.org.
D000368:Aged; D000369:Aged, 80 and over; D015505:Chest Tubes; D004322:Drainage / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging; D008297:Male; D010996:Pleural Effusion / Q000628:therapy*; D012189:Retrospective Studies; D013907:Thoracostomy; D013997:Time Factors; D016896:Treatment Outcome; D014463:Ultrasonography; D015300:Ventilator Weaning / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*