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

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• 作者：Ewan C Goligher (1) (2)
  Jerome A Leis (2)
  Robert A Fowler (3)
  Ruxandra Pinto (3)
  Neill KJ Adhikari (3)
  Niall D Ferguson (1) (4)
  
• 刊名：Critical Care
• 出版年：2011
• 出版时间：December 2011
• 年：2011
• 卷：15
• 期：1
• 全文大小：
• 作者单位：Ewan C Goligher (1) (2)
  Jerome A Leis (2)
  Robert A Fowler (3)
  Ruxandra Pinto (3)
  Neill KJ Adhikari (3)
  Niall D Ferguson (1) (4)
  
  1. Interdepartmental Division of Critical Care, Mount Sinai Hospital and the University Health Network, University of Toronto, 600 University Avenue, Toronto, Ontario, M5G 1X5, Canada
  2. Department of Medicine, Mount Sinai Hospital and the University Health Network, University of Toronto, 600 University Avenue, Toronto, Ontario, M5G 1X5, Canada
  3. Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, and the Interdepartmental Division of Critical Care, University of Toronto, 2075 Bayview Avenue, Toronto, Ontario, M4N 3M5, Canada
  4. Department of Medicine, Division of Respirology, Mt. Sinai Hospital and the University Health Network, and the Interdepartmental Division of Critical Care, University of Toronto, 600 University Avenue, Toronto, Ontario, M5G 1X5, Canada
  
• ISSN：1364-8535

文摘

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.