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critical care reviews: Yanick Beaulieu and Paul E. Marik Bedside Ultrasonography in the ICU: Part 2 Chest 2005; 128: 1766-1781 [Abstract] [Full text] [PDF]

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Draining all effusions in critically ill patients?

Peter E Spronk, Wim ten Hove, and Marcus J. Schultz   (24 October 2005)

Draining all effusions in critically ill patients? 24 October 2005
Peter E Spronk, intensivist Gelre Hospitals (Lukas site), Dept. of Intensive Care Medicine, Apeldoorn, the Netherlands, Wim ten Hove, and Marcus J. Schultz Send letter to journal: Re: Draining all effusions in critically ill patients? p.spronk{at}gelre.nl Peter E Spronk, et al.	Sir – In this journal Beaulieu et al. reviewed the value of bedside ultrasonography of critically ill patients (ICU) [1]. They are to be congratulated on their review but fail to describe the relation between ultrasonographic demonstration of effusions and therapeutic interventions. Quantitative estimation of pleural fluid by ultrasound is feasible [2] and ultrasound guided drainage of pleural fluid seems to be safe. The bottom question is when, if ever, pleural effusions in critically ill patients should be drained. Indeed, clinical studies should be undertaken to examine the risks/benefits of careful removal of pleural fluid in patients with pleural effusions, when oxygenation is impaired during mechanical ventilation [3]. The same holds true for the detection of ascites. The demonstration of abdominal fluid by ultrasound might mandate puncture for microbial analysis to rule out infection, or bowel perforation, among other diagnoses. Also, if abdominal compartment syndrome is present with an impairment of intestinal perfusion and ventilation, draining of abdominal fluid may buy some time until surgical intervention can be performed [4]. However, also in the case of ascites, it remains to be determined in what situations drainage is beneficial in the critically ill. Ultrasonography is an important diagnostic tool in the ICU for the detection of effusions. Studies are needed to determine when to drain these effusions. References 1. Beaulieu Y, Marik PE. Bedside ultrasonography in the ICU. Chest 2005;128:1766-1781 2.Vignon P, Chastagner C, Berkane V, et al. Quantitative assessment of pleural effusion in critically ill patients by means of ultrasonography. Crit Care Med 2005;33:1-7 3.Nishida O, Arellano R, Cheng DC, et al. Gas exchange and hemodynamics in experimental pleural effusion. Crit Care Med 1999 Mar;27(3):583-7 4.Reckard JM, Chung MH, Varma MK, Zagorski SM. Management of intraabdominal hypertension by percutaneous catheter drainage. J Vasc Interv Radiol. 2005 Jul;16(7):1019-21