Ultrasound-Guided Pleural Effusion Drainage: Effect on Oxygenation, Respiratory Mechanics, and Liberation from Mechanical Ventilation in Surgical Intensive Care Unit Patients

The question as to whether an aggressive management of post-operative pleural effusion may improve clinical outcomes after major surgery remains unanswered. The aim of this study was to investigate the effect of ultrasound-guided pleural effusion drainage on oxygenation, respiratory mechanics, and l...

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Autores principales:	Hsin-Yueh Fang, Ko-Wei Chang, Yin-Kai Chao
Formato:	article
Lenguaje:	EN
Publicado:	MDPI AG 2021
Materias:	post-operative pleural effusion ultrasound drainage oxygenation lung mechanics Medicine (General) R5-920
Acceso en línea:	https://doaj.org/article/ac99b8d661f9446686b9fc47a0fb7aa6
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spelling	oai:doaj.org-article:ac99b8d661f9446686b9fc47a0fb7aa62021-11-25T17:20:37ZUltrasound-Guided Pleural Effusion Drainage: Effect on Oxygenation, Respiratory Mechanics, and Liberation from Mechanical Ventilation in Surgical Intensive Care Unit Patients10.3390/diagnostics111120002075-4418https://doaj.org/article/ac99b8d661f9446686b9fc47a0fb7aa62021-10-01T00:00:00Zhttps://www.mdpi.com/2075-4418/11/11/2000https://doaj.org/toc/2075-4418The question as to whether an aggressive management of post-operative pleural effusion may improve clinical outcomes after major surgery remains unanswered. The aim of this study was to investigate the effect of ultrasound-guided pleural effusion drainage on oxygenation, respiratory mechanics, and liberation from mechanical ventilation in surgical intensive care unit patients. Oxygenation and respiratory mechanics were measured before and after drainage. Over an 18-month period, a total of 62 patients were analyzed. The mean drainage volume during the first 24 h was 864 ± 493 mL, and there were no procedural complications. Both the mean PaO<sub>2</sub>/FiO<sub>2</sub> ratio and lung compliance improved after drainage. Additionally, 41.9% (<i>n</i> = 26) of patients were ventilator-free within 72 h after drainage. Multivariable logistic regression analysis revealed that non-cardiovascular or thoracic surgery (odds ratio [OR] = 4.968, <i>p</i> = 0.046), a longer time interval from operation to the onset of pleural effusion (OR = 1.165, <i>p</i> = 0.005), and a higher peak airway pressure (OR = 1.303, <i>p</i> = 0.009) were independent adverse predictors for being free from mechanical ventilation within 72 h after drainage. Specifically, patients with a time from surgery to the onset of pleural effusion ≤6 days—but not those with an interval >6 days—showed a significant post-procedural improvement in terms of PaO<sub>2</sub>/FiO<sub>2</sub> ratio, PaCO<sub>2</sub>, peak airway pressure, and dynamic lung compliance. In summary, ultrasound-guided pleural effusion drainage resulted in significant clinical benefits in mechanically ventilated ICU patients after major surgery—especially in those with early-onset effusion who received thoracic surgery.Hsin-Yueh FangKo-Wei ChangYin-Kai ChaoMDPI AGarticlepost-operative pleural effusionultrasounddrainageoxygenationlung mechanicsMedicine (General)R5-920ENDiagnostics, Vol 11, Iss 2000, p 2000 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	post-operative pleural effusion ultrasound drainage oxygenation lung mechanics Medicine (General) R5-920
spellingShingle	post-operative pleural effusion ultrasound drainage oxygenation lung mechanics Medicine (General) R5-920 Hsin-Yueh Fang Ko-Wei Chang Yin-Kai Chao Ultrasound-Guided Pleural Effusion Drainage: Effect on Oxygenation, Respiratory Mechanics, and Liberation from Mechanical Ventilation in Surgical Intensive Care Unit Patients
description	The question as to whether an aggressive management of post-operative pleural effusion may improve clinical outcomes after major surgery remains unanswered. The aim of this study was to investigate the effect of ultrasound-guided pleural effusion drainage on oxygenation, respiratory mechanics, and liberation from mechanical ventilation in surgical intensive care unit patients. Oxygenation and respiratory mechanics were measured before and after drainage. Over an 18-month period, a total of 62 patients were analyzed. The mean drainage volume during the first 24 h was 864 ± 493 mL, and there were no procedural complications. Both the mean PaO<sub>2</sub>/FiO<sub>2</sub> ratio and lung compliance improved after drainage. Additionally, 41.9% (<i>n</i> = 26) of patients were ventilator-free within 72 h after drainage. Multivariable logistic regression analysis revealed that non-cardiovascular or thoracic surgery (odds ratio [OR] = 4.968, <i>p</i> = 0.046), a longer time interval from operation to the onset of pleural effusion (OR = 1.165, <i>p</i> = 0.005), and a higher peak airway pressure (OR = 1.303, <i>p</i> = 0.009) were independent adverse predictors for being free from mechanical ventilation within 72 h after drainage. Specifically, patients with a time from surgery to the onset of pleural effusion ≤6 days—but not those with an interval >6 days—showed a significant post-procedural improvement in terms of PaO<sub>2</sub>/FiO<sub>2</sub> ratio, PaCO<sub>2</sub>, peak airway pressure, and dynamic lung compliance. In summary, ultrasound-guided pleural effusion drainage resulted in significant clinical benefits in mechanically ventilated ICU patients after major surgery—especially in those with early-onset effusion who received thoracic surgery.
format	article
author	Hsin-Yueh Fang Ko-Wei Chang Yin-Kai Chao
author_facet	Hsin-Yueh Fang Ko-Wei Chang Yin-Kai Chao
author_sort	Hsin-Yueh Fang
title	Ultrasound-Guided Pleural Effusion Drainage: Effect on Oxygenation, Respiratory Mechanics, and Liberation from Mechanical Ventilation in Surgical Intensive Care Unit Patients
title_short	Ultrasound-Guided Pleural Effusion Drainage: Effect on Oxygenation, Respiratory Mechanics, and Liberation from Mechanical Ventilation in Surgical Intensive Care Unit Patients
title_full	Ultrasound-Guided Pleural Effusion Drainage: Effect on Oxygenation, Respiratory Mechanics, and Liberation from Mechanical Ventilation in Surgical Intensive Care Unit Patients
title_fullStr	Ultrasound-Guided Pleural Effusion Drainage: Effect on Oxygenation, Respiratory Mechanics, and Liberation from Mechanical Ventilation in Surgical Intensive Care Unit Patients
title_full_unstemmed	Ultrasound-Guided Pleural Effusion Drainage: Effect on Oxygenation, Respiratory Mechanics, and Liberation from Mechanical Ventilation in Surgical Intensive Care Unit Patients
title_sort	ultrasound-guided pleural effusion drainage: effect on oxygenation, respiratory mechanics, and liberation from mechanical ventilation in surgical intensive care unit patients
publisher	MDPI AG
publishDate	2021
url	https://doaj.org/article/ac99b8d661f9446686b9fc47a0fb7aa6
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Ultrasound-Guided Pleural Effusion Drainage: Effect on Oxygenation, Respiratory Mechanics, and Liberation from Mechanical Ventilation in Surgical Intensive Care Unit Patients

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