Intensive Care Medicine

, 35:350 | Cite as

Application of ultrasound-guided pigtail catheter for drainage of pleural effusions in the ICU

  • Shinn-Jye Liang
  • Chih-Yen Tu
  • Hung-Jen Chen
  • Chia-Hung Chen
  • Wei ChenEmail author
  • Chuen-Ming Shih
  • Wu-Huei Hsu
Brief Report



Little is known about the effectiveness of the pigtail catheter for drainage of pleural effusions in the intensive care unit (ICU).


We conducted a retrospective review of adult patients (≥18 years) who underwent ultrasound-guided pigtail catheter drainage of pleural effusions in the ICUs from January 2005 to July 2007 in a university hospital.


Among the 133 enrolled patients, there were 93 (70%) males and 40 (30%) females, with a mean age of 63.7 ± 15.4 years old. The reasons for pigtail drainage were as follows: thoracic empyema (n = 59, 44%), massive transudative pleural effusions (n = 33, 25%), postoperative pleural effusion (n = 29, 15%), malignant pleural effusion (n = 18, 14%) and traumatic hemothorax (n = 3, 2%). In comparing the total amount of fluids drained, the duration of drainage, success rate and complication rate among these different causes of pleural effusion, pigtail drainage for massive transudative pleural effusion yielded the largest amount of pleural fluids (5,382 ± 4,844 ml), provided the longest duration of drainage (9 ± 7 days), and had the highest complication rate (18%). The success rate was highest when used to treat traumatic hemothorax (100%) and postoperative pleural effusions (85%); drains inserted for empyema were more likely to fail (overall success rate, 42%). No significant insertion complications, such as hollow organ perforation, were caused by this procedure.


The ultrasound-guided pigtail catheter inserted by intensivists is a well-tolerated and effective method of draining all kinds of pleural effusions in critically ill patients. We suggest that pigtail catheter drainage be considered as the initial treatment of choice in the ICU.


Ultrasound Pigtail Critically ill ICU Pleural effusion 



Intensive care unit


Acute physiology and chronic health evaluation


Conflict of interest statement

No authors have a conflict of interest to disclose.


  1. 1.
    Mattison LE, Coppage L, Alderman DF, Herlong JO, Sahn SA (1997) Pleural effusions in the medical ICU: prevalence, causes, and clinical implications. Chest 111:1018–1023PubMedCrossRefGoogle Scholar
  2. 2.
    Andrews P, Azoulay E, Antonelli M, Brochard L, Brun-Buisson C, De Backer D, Dobb G, Fagon JY, Gerlach H, Groeneveld J, Macrae D, Mancebo J, Metnitz P, Nava S, Pugin J, Pinsky M, Radermacher P, Richard C (2007) Year in review in Intensive Care Medicine, 2006. II. Infections and sepsis, haemodynamics, elderly, invasive and noninvasive mechanical ventilation, weaning, ARDS. Intensive Care Med 33:214–229PubMedCrossRefGoogle Scholar
  3. 3.
    Tu CY, Hsu WH, Hsia TC, Chen HJ, Chiu KL, Hang LW, Shih CM (2006) The changing pathogens of complicated parapneumonic effusions or empyemas in a medical intensive care unit. Intensive Care Med 32:570–576PubMedCrossRefGoogle Scholar
  4. 4.
    Parker LA, Charnock GC, Delany DJ (1989) Small bore catheter drainage and sclerotherapy for malignant pleural effusions. Cancer 64:1218–1221PubMedCrossRefGoogle Scholar
  5. 5.
    Lai YF, Chao TY, Wang YH, Lin AS (2003) Pigtail drainage in the treatment of tuberculous pleural effusions: a randomised study. Thorax 58:149–151PubMedCrossRefGoogle Scholar
  6. 6.
    Horsley A, Jones L, White J, Henry M (2006) Efficacy and complications of small-bore, wire-guided chest drains. Chest 130:1857–1863PubMedCrossRefGoogle Scholar
  7. 7.
    Liu CM, Hang LW, Chen WK, Hsia TC, Hsu WH (2003) Pigtail tube drainage in the treatment of spontaneous pneumothorax. Am J Emerg Med 21:241–244PubMedCrossRefGoogle Scholar
  8. 8.
    Chen CH, Chen W, Hsu WH (2006) Pigtail catheter drainage for secondary spontaneous pneumothorax. QJM 99:489–491PubMedCrossRefGoogle Scholar
  9. 9.
    Tsai WK, Chen W, Lee JC, Cheng WE, Chen CH, Hsu WH, Shih CM (2006) Pigtail catheters vs large-bore chest tubes for management of secondary spontaneous pneumothoraces in adults. Am J Emerg Med 24:795–800PubMedCrossRefGoogle Scholar
  10. 10.
    Colice GL, Curtis A, Deslauriers J, Heffner J, Light R, Littenberg B, Sahn S, Weinstein RA, Yusen RD (2000) Medical and surgical treatment of parapneumonic effusions : an evidence-based guideline. Chest 118:1158–1171PubMedCrossRefGoogle Scholar
  11. 11.
    Light RW, Macgregor MI, Luchsinger PC, Ball WC Jr (1972) Pleural effusions: the diagnostic separation of transudates and exudates. Ann Intern Med 77:507–513PubMedGoogle Scholar
  12. 12.
    Saffran L, Ost DE, Fein AM, Schiff MJ (2000) Outpatient pleurodesis of malignant pleural effusions using a small-bore pigtail catheter. Chest 118:417–421PubMedCrossRefGoogle Scholar
  13. 13.
    Bjessmo S, Hylander S, Vedin J, Mohlkert D, Ivert T (2007) Comparison of three different chest drainages after coronary artery bypass surgery: a randomised trial in 150 patients. Eur J Cardiothorac Surg 31:372–375PubMedCrossRefGoogle Scholar
  14. 14.
    Adrales G, Huynh T, Broering B, Sing RF, Miles W, Thomason MH, Jacobs DG (2002) A thoracostomy tube guideline improves management efficiency in trauma patients. J Trauma 52:210–214 (discussion 214–216)PubMedCrossRefGoogle Scholar
  15. 15.
    Yang PC, Luh KT, Chang DB, Wu HD, Yu CJ, Kuo SH (1992) Value of sonography in determining the nature of pleural effusion: analysis of 320 cases. AJR Am J Roentgenol 159:29–33PubMedGoogle Scholar
  16. 16.
    Mynarek G, Brabrand K, Jakobsen JA, Kolbenstvedt A (2004) Complications following ultrasound-guided thoracocentesis. Acta Radiol 45:519–522PubMedCrossRefGoogle Scholar
  17. 17.
    Balik M, Plasil P, Waldauf P, Pazout J, Fric M, Otahal M, Pachl J (2006) Ultrasound estimation of volume of pleural fluid in mechanically ventilated patients. Intensive Care Med 32:318–321PubMedCrossRefGoogle Scholar
  18. 18.
    Roberts JS, Bratton SL, Brogan TV (1998) Efficacy and complications of percutaneous pigtail catheters for thoracostomy in pediatric patients. Chest 114:1116–1121PubMedCrossRefGoogle Scholar
  19. 19.
    Goksin I, Baltalarli A, Sacar M, Sungurtekin H, Ozcan V, Gurses E, Kaya S, Evrengul H (2006) Preservation of pleural integrity in patients undergoing coronary artery bypass grafting: effect on postoperative bleeding and respiratory function. Acta Cardiol 61:89–94PubMedCrossRefGoogle Scholar
  20. 20.
    Yan JJ, Zhang XH, Chu KJ, Huang L, Zhou FG, Yan YQ (2005) Prevention and management of pleural effusion following hepatectomy in primary liver cancer. Hepatobiliary Pancreat Dis Int 4:375–378PubMedGoogle Scholar
  21. 21.
    Shitrit D, Izbicki G, Fink G, Bendayan D, Aravot D, Saute M, Kramer MR (2003) Late postoperative pleural effusion following lung transplantation: characteristics and clinical implications. Eur J Cardiothorac Surg 23:494–496PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  • Shinn-Jye Liang
    • 1
  • Chih-Yen Tu
    • 1
  • Hung-Jen Chen
    • 1
  • Chia-Hung Chen
    • 1
  • Wei Chen
    • 1
    Email author
  • Chuen-Ming Shih
    • 1
  • Wu-Huei Hsu
    • 1
  1. 1.Division of Pulmonary and Critical Care Medicine, Department of Internal MedicineChina Medical University Hospital, TaichungTaichungTaiwan

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