Pleural diseases are common in the critically ill patient. These include not only pleural effusions of different etiologies, but also pneumothoraces, hemothoraces and rarely pleural tumors. Pleural effusions, if large, can affect gas exchange, hemodynamic stability and respiratory dynamics (Brogi E, et al. Crit Care 21(1):325, 2017). This chapter is aimed at clinicians on the frontline, with the goal to provide the latest evidence on pleural disease in critically ill patients, outlining the principles of general management and areas of future research.
KeywordsPleural disease Pneumothorax Critical care illness
Conflicts of Interest: J.C.G. and F.M.: This work in original and all authors meet the criteria for authorship, including acceptance of responsibility for the scientific content of the manuscript. This paper is not under consideration in any other Journal and all the authors have read and approved the content of the manuscript.
No potential conflict of interest exists with any companies or organizations whose products or services may be discussed in this article. This paper has not been funded by the National Institutes of Health (NIH), the Wellcome Trust or their agencies.
Isoechoic pleural effusion. This video shows a large isoechoic left sided pleural effusion. Increased ultrasonographic echogenicity of the pleural fluid suggests an exudative process (MOV 4165 kb)
Large pleural effusion. This video shows a simple large anechoic pleural effusion in a patient with fluid overload. Notice the absence of both hematocrit sign and septations (MOV 3800 kb)
Simple right sided pleural effusion with trapped lung. This video shows a large anechoic right sided pleural effusion in a patient with hepatic hydrothorax. Notice the minimal movement of the atelectactic lung. Pleural manometry showed initial negative pleural pressures, confirming non-reexpandable (trapped) lung (MOV 4531 kb)
Small left sided pleural effusion. This video shows a simple anechoic small pleural effusion. These finding in the vast majority of critical care patients is not of major clinical significance and should be monitored (MOV 5196 kb)
Complicated parapneumonic pleural effusion. This video shows a large right sided pleural effusion, with multiple mobile echoic lines (septations) within the pleural space, a finding suggestive of complicated parapneumonic pleural effusion. The pleural fluid analysis confirmed biliothorax (MOV 3806 kb)
Left sided hydropneumothorax. This video shows a moderate size left sided pleural effusion with air leak, in the setting of an esophageal perforation.The multiple mobile hyperechoic foci represent the bubbles of air in the pleural space (MOV 3854 kb)
Pigtail in pleural effusion. This video shows the presence of two parallel curvilinear hyperechoic lines within a large pleural effusion representing the tip of the pigtail (MOV 8998 kb)
Vascular ultrasound, identification of intercostal artery. This video shows a normal intercostal artery located at the lower border of the proximal rib, identified as a pulsatile red area using color Doppler (MOV 4175 kb)
Lung point. This video shows a “lung point” sign, which confirms the presence of pneumothorax. The pleural drainage catheter should be placed cephalad to this area. (MOV 4290 kb)
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