PURPOSE: The standard treatment of transudative pleural effusions is reating the underlying cause. Pleural effusions, however, significantly alter respiratory mechanics and gas exchange, and can therefore prolong respiratory failure. We prospectively studied the effect of pigtail catheter drainage of pleural effusions in patients requiring mechanical ventilatory support.
METHODS: Patients with significant pleural effusions requiring mechanical ventilatory support underwent diagnostic thoracentesis. Patients with transudative effusions were then randomized into standard care versus standard care plus pigtail catheter drainage of the pleural fluid. A 14F pigtail cather was inserted under ultrasound guidance using a Seldinger technique. The duration of total mechanical ventilation, the percentage of patients liberated within 48-hours of study entry, the volume of fluid drained, and complications associated with the procedure were studied.
RESULTS: 168 patients were enrolled; 80 underwent pigtail drainage; 88 received only standard care. There were no demographic differences between the two groups. The average volume of fluid drained in the first 24-hours was 1220 mL (±150 mL). The average duration of pigtail drainage was 2.8 days. 61 patients (76%) that underwent pigtail drainage were liberated from mechanical ventilatory support within 48 hours, while only 46 patients (52%) that received only standard care were liberated during this period (P=0.03). The average duration of mechanical ventilatory support was 3.8 days in patients who underwent pigtail drainage versus 6.5 days in standard care group (P=0.01). No significant complications were noted with pigtail catheter treatment. 95% of the effusions were completely drained with the use of the pigtail catheter.
CONCLUSION: Pigtail catheter drainage of pleural effusions results in faster liberation from mechanical ventilatory support. It is a safe procedure when performed under ultrasound guidance.
CLINICAL IMPLICATIONS: Pigtail catheter drainage of pleural effusions hastens the liberation from mechanical ventilatory support.
DISCLOSURE: Adesoji Adenigbagbe, No Financial Disclosure Information; No Product/Research Disclosure Information