Document Detail

Pleural effusion in the mechanically ventilated patient.
MedLine Citation:
PMID:  19179867     Owner:  NLM     Status:  MEDLINE    
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.
Jerónimo Graf
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't; Review    
Journal Detail:
Title:  Current opinion in critical care     Volume:  15     ISSN:  1531-7072     ISO Abbreviation:  Curr Opin Crit Care     Publication Date:  2009 Feb 
Date Detail:
Created Date:  2009-01-30     Completed Date:  2009-05-06     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9504454     Medline TA:  Curr Opin Crit Care     Country:  United States    
Other Details:
Languages:  eng     Pagination:  10-7     Citation Subset:  IM    
Pulmonary Research, Regions Hospital, University of Minnesota, St. Paul, Minnesota 55101, USA.
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MeSH Terms
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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