| Pleural effusion in the mechanically ventilated patient. | |
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MedLine Citation:
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PMID: 19179867 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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PURPOSE OF REVIEW: Pleural effusions (PLEF) occur frequently in mechanically ventilated patients (MVP). There have been improvements in bedside diagnosis, quantification, and drainage techniques. Nevertheless, information on the impact of PLEF on heart-lung performance and pathophysiologic considerations for drainage in MVP is limited. RECENT FINDINGS: Only four studies on physiological effects of PLEF drainage in MVP were found. Variable oxygenation response is reported. Older work suggests that the space occupying effect of PLEF is shared between chest wall expansion and lung collapse. Normally, the compliant chest wall accepts most of it, buffering its effects on lung volume and gas exchange. In MVP chest wall compliance and airway pressure probably play major roles on the response to PLEF drainage. PLEF reduces inspiratory muscle efficiency; hence drainage can help in weaning. PLEF can increase heart filling and pericardial pressures, dissociating intrathoracic vascular pressures from preload. Tamponade-like effects with diastolic chamber collapse and circulatory impairment that reverses with PLEF drainage have been reported. SUMMARY: PLEF drainage does not always improve oxygenation in MVP with acute respiratory failure. An assessment of chest wall compliance and a lung recruitment maneuver may help predict the response. Procedural complication risks should be considered when choosing the best approach. |
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Authors:
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Jerónimo Graf |
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Publication Detail:
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Type: Journal Article; Research Support, Non-U.S. Gov't; Review |
Journal Detail:
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Title: Current opinion in critical care Volume: 15 ISSN: 1531-7072 ISO Abbreviation: Curr Opin Crit Care Publication Date: 2009 Feb |
Date Detail:
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Created Date: 2009-01-30 Completed Date: 2009-05-06 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 9504454 Medline TA: Curr Opin Crit Care Country: United States |
Other Details:
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Languages: eng Pagination: 10-7 Citation Subset: IM |
Affiliation:
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Pulmonary Research, Regions Hospital, University of Minnesota, St. Paul, Minnesota 55101, USA. jeronimograf@yahoo.com |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Drainage Humans Pleural Effusion / physiopathology*, therapy Respiration, Artificial / adverse effects* Respiratory Physiological Processes |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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