Management of pleural effusion in mechanically ventilated critically ill patients: A systematic review and guideline.

Background: Mechanically ventilated critically ill patients often develop pleural effusions, which may impact lung compliance and expansion. This systematic review explores the management of pleural effusion in the critically ill population.

Methods: A comprehensive literature search was performed. Quality of evidence rating and recommendation development utilized Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology.

Results: The full search retrieved 11,965 articles for screening, of which 28 studies ultimately met inclusion criteria. There were 15 cohort studies assessing oxygenation outcome and 17 cohort studies assessing pneumothorax outcome. Patients with drainage (n ​= ​418) had a pooled mean increase in PaO2/FiO2 ratio of 53 (P ​< ​0.00001, 95 ​% CI: 43-64, I² ​= ​0 ​%) compared to pre-drainage/no-drainage (n ​= ​432). In patients with drainage, the combined incidence of pneumothorax was 124/5995 (2.1 ​%).

Conclusion: In mechanically ventilated critically ill adult patients with pleural effusion and hypoxia, we conditionally recommend drainage of pleural effusion to improve oxygenation. P:F ratio <200 and pleural effusion volume estimate >500 ​mL are conditions in which drainage would have most benefit.