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World J Clin Cases. Feb 16, 2023; 11(5): 989-999
Published online Feb 16, 2023. doi: 10.12998/wjcc.v11.i5.989
Pleural effusion in critically ill patients and intensive care setting
Adel Salah Bediwy, Mohammed Al-Biltagi, Nermin Kamal Saeed, Hosameldin A Bediwy, Reem Elbeltagi
Adel Salah Bediwy, Department of Chest Diseases, Faculty of Medicine, Tanta University, Tanta 31527, Algharbia, Egypt
Adel Salah Bediwy, Department of Chest Diseases, University Medical Center, Arabian Gulf University, Dr. Sulaiman Al Habib Medical Group, Manama 26671, Bahrain
Mohammed Al-Biltagi, Department of Pediatric, Faculty of Medicine, Tanta University, Tanta 31527, Algharbia, Egypt
Mohammed Al-Biltagi, Department of Pediatric, University Medical Center, King Abdulla Medical City, Arabian Gulf University, Dr. Sulaiman Al Habib Medical Group, Manama 26671, Bahrain
Nermin Kamal Saeed, Medical Microbiology Section, Chairperson of the Pathology Department, Salmaniya Medical Complex, Ministry of Health, Kingdom of Bahrain, Manama 26671, Bahrain
Nermin Kamal Saeed, Microbiology Section, Pathology Department, Royal College of Surgeons in Ireland - Bahrain, Busiateen 15503, Muharraq, Bahrain
Hosameldin A Bediwy, Faculty of Medicine, Tanta University, Tanta 31527, Algharbia, Egypt
Reem Elbeltagi, Department of Medicine, Royal College of Surgeons in Ireland - Bahrain, Busaiteen 15503, Muharraq, Bahrain
Author contributions: All authors collected the data, wrote, and revised the manuscript.
Conflict-of-interest statement: All authors declare no conflict of interest for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Mohammed Al-Biltagi, MBChB, MD, MSc, PhD, Academic Editor, Chairman, Consultant Physician-Scientist, Professor, Researcher, Department of Pediatric, Faculty of Medicine, Tanta University, Albahr Street, Medical Complex, Tanta 31527, Algharbia, Egypt. mbelrem@hotmail.com
Received: December 2, 2022
Peer-review started: December 2, 2022
First decision: January 17, 2023
Revised: January 17, 2023
Accepted: January 28, 2023
Article in press: January 28, 2023
Published online: February 16, 2023
Processing time: 73 Days and 13.4 Hours
Abstract

Pleural effusion usually causes a diagnostic dilemma with a long list of differential diagnoses. Many studies found a high prevalence of pleural effusions in critically ill and mechanically ventilated patients, with a wide range of variable prevalence rates of up to 50%-60% in some studies. This review emphasizes the importance of pleural effusion diagnosis and management in patients admitted to the intensive care unit (ICU). The original disease that caused pleural effusion can be the exact cause of ICU admission. There is an impairment in the pleural fluid turnover and cycling in critically ill and mechanically ventilated patients. There are also many difficulties in diagnosing pleural effusion in the ICU, including clinical, radiological, and even laboratory difficulties. These difficulties are due to unusual presentation, inability to undergo some diagnostic procedures, and heterogenous results of some of the performed tests. Pleural effusion can affect the patient’s outcome and prognosis due to the hemodynamics and lung mechanics changes in these patients, who usually have frequent comorbidities. Similarly, pleural effusion drainage can modify the ICU-admitted patient’s outcome. Finally, pleural effusion analysis can change the original diagnosis in some cases and redirect the management toward a different way.

Keywords: Pleural effusion; Intensive care unit; Mechanical ventilation; Diagnosis; Drainage; Pigtail catheters

Core Tip: Pleural effusion has a high prevalence in critically ill patients. It poses a significant challenge in the intensive care unit with diagnostic and therapeutic difficulties. These difficulties are due to unusual presentation, inability to undergo some diagnostic procedures, and heterogenous results of some of the performed tests. Pleural effusion impacts the outcome in patients who need intensive care unit care. Consequently, proper management of pleural effusion significantly improves the patient’s prognosis.