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Clinical Investigations in Critical Care |

Clinically Documented Pleural Effusions in Medical ICU Patients*: How Useful Is Routine Thoracentesis?

Muriel Fartoukh, MD; Elie Azoulay, MD; Richard Galliot, MD; Jean-Roger Le Gall, MD; Frederic Baud, MD; Sylvie Chevret, MD; Benoı̂t Schlemmer, MD
Author and Funding Information

*From the Medical and Respiratory Intensive Care Unit (Dr. Fartoukh), Antoine Béclère Teaching Hospital; Medical Intensive Care Unit (Drs. Azoulay, Le Gall, and Schlemmer) and Biostatistics Department (Dr. Chevret), Saint Louis Teaching Hospital and Paris 7 University; and Medical Intensive Care Unit (Drs. Galliot and Baud), Lariboisière Teaching Hospital, Paris, France.

Correspondence to: Elie Azoulay, MD, Medical ICU, Saint Louis Teaching Hospital, 1 avenue Claude Vellefaux, 75010 Paris, France; e-mail: elie.azoulay@sls.ap-hop-paris.fr



Chest. 2002;121(1):178-184. doi:10.1378/chest.121.1.178
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Study objectives: To assess the impact of routine thoracentesis on diagnostic assessment and therapeutic measures in patients with clinically documented pleural effusions.

Design and setting: Prospective, 1-year, three-center study in medical ICU (MICU) patients with physical and radiographic evidence of pleural effusion.

Patients: Of 1,351 patients admitted to three MICUs during the study period, 113 patients had physical and radiographic evidence of pleural effusion, yielding an annual incidence of 8.4%.

Intervention: Routine thoracentesis in 82 patients without contraindications to thoracentesis.

Measurements and results: Twenty patients (24.4%) had a transudate, 35 patients (42.7%) had an infectious exudate (parapneumonic, n = 21; empyema, n = 14), and 27 patients (32.9%) had a noninfectious exudate. Laboratory parameters including the leukocyte count, the neutrophil percentage in pleural fluid, and the fluid/serum protein and lactate dehydrogenase ratios differed significantly among the three groups. Thoracentesis yielded improvements in the diagnosis and/or treatment in 46 patients (56%): the presumptive (prethoracentesis) diagnosis was changed in 37 patients (32 patients with certain benefit and 5 patients with probable benefit from thoracentesis), of whom 27 patients received a change in treatment based on the new diagnosis; 9 other patients received a change in treatment although the diagnosis remained the same. The only complications were pneumothorax in six patients (7%), all with a favorable outcome after drainage.

Conclusion: Infection was the main cause of pleural effusions detected based on physical and radiographic findings in our MICU population. Routine thoracentesis proved a simple and safe means of improving the diagnosis and treatment.


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