Acute and Critical Care

Original Article

Cardiology
Clinical implications of pleural effusion following left ventricular assist device implantation: So-Min Lim, Ah-Ram Kim, Junho Hyun, Sang-Eun Lee, Pil-Je Kang, Sung-Ho Jung, Min-Seok Kim; Acute Crit Care. 2024;39(1):169-178. Published online January 17, 2024; DOI: https://doi.org/10.4266/acc.2023.01102

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Background
Studies on the association between pleural effusion (PE) and left ventricular assist devices (LVADs) are limited. This study aimed to examine the characteristics and the clinical impact of PE following LVAD implantation. Methods: This study is a prospective analysis of patients who underwent LVAD implantation from June 2015 to December 2022. We investigated the prognostic impact of therapeutic drainage (TD) on clinical outcomes. We also compared the characteristics and clinical outcomes between early and late PE and examined the factors related to the development of late PE. Results: A total of 71 patients was analyzed. The TD group (n=45) had a longer ward stay (days; median [interquartile range]: 31.0 [23.0–46.0] vs. 21.0 [16.0–34.0], P=0.006) and total hospital stay (47.0 [36.0–82.0] vs. 31.0 [22.0–48.0], P=0.002) compared to the no TD group (n=26). Early PE was mostly exudate, left-sided, and neutrophil-dominant even though predominance of lymphocytes was the most common finding in late PE. Patients with late PE had a higher rate of reintubation within 14 days (31.8% vs. 4.1%, P=0.004) and longer hospital stays than those without late PE (67.0 [43.0–104.0] vs. 36.0 [28.0–48.0], P<0.001). Subgroup analysis indicated that female sex, low body mass index, cardiac resynchronization therapy, and hypoalbuminemia were associated with late PE. Conclusions: Compared to patients not undergoing TD, those undergoing TD had a longer hospital stay but not a higher 90-day mortality. Patients with late PE had poor clinical outcomes. Therefore, the correction of risk factors, like hypoalbuminemia, may be required.

Citations

Citations to this article as recorded by

Nuances of pleural effusion after left ventricular assist devices implantation: insights from therapeutic drainage and preoperative predictors
Huijin Lee, Jeehoon Kang
Acute and Critical Care.2024; 39(1): 192. CrossRef

Review Article

Pulmonary
Lung ultrasound for evaluation of dyspnea: a pictorial review: Aparna Murali, Anjali Prakash, Rashmi Dixit, Monica Juneja, Naresh Kumar; Acute Crit Care. 2022;37(4):502-515. Published online November 21, 2022; DOI: https://doi.org/10.4266/acc.2022.00780

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Abstract PDF Supplementary Material: Lung ultrasound is based on the analysis of ultrasound artifacts generated by the pleura and air within the lungs. In recent years, lung ultrasound has emerged as an important alternative for quick evaluation of the patient at the bedside. Several techniques and protocols for performing lung ultrasound have been described in the literature, with the most popular one being the Bedside Lung Ultrasound in Emergency (BLUE) protocol which can be utilized to diagnose the cause of acute dyspnea at the bedside. We attempt to provide a simplified approach to understanding the physics behind the artifacts used in lung ultrasound, the imaging techniques, and the application of the BLUE protocol to diagnose the commonly presenting causes of acute dyspnea.

Case Report

Pulmonary
Central Venous Catheter-Related Hydrothorax: Se Hun Kim, Charles Her; Korean J Crit Care Med. 2015;30(4):343-348. Published online November 30, 2015; DOI: https://doi.org/10.4266/kjccm.2015.30.4.343

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Abstract PDF: This report describes a case of 88-year-old women who developed central venous catheter-related bilateral hydrothorax, in which left pleural effusion, while right pleural effusion was being drained. The drainage prevented accumulation of fluid in the right pleural space, indicating that there was neither extravasation of infusion fluid nor connection between the two pleural cavities. The only explanation for bilateral hydrothorax in this case is lymphatic connections. Although vascular injuries by central venous catheter can cause catheter-related hydrothorax, it is most likely that the positioning of the tip of central venous catheter within the lymphatic duct opening in the right sub-clavian-jugular confluence or superior vena cava causes the catheter-related hydrothorax. Pericardial effusion can also result from retrograde lymphatic flow through the pulmonary lymphatic chains.

Original Articles

Pulmonary
The Usefulness of Intensivist-Performed Bedside Drainage of Pleural Effusion via Ultrasound-Guided Pigtail Catheter: Joo Won Min, Joon Young Ohm, Byung Seok Shin, Jun Wan Lee, Sang Il Park, Seok Hwa Yoon, Yong Sup Shin, Dong Il Park, Chaeuk Chung, Jae Young Moon; Korean J Crit Care Med. 2014;29(3):177-182. Published online August 31, 2014; DOI: https://doi.org/10.4266/kjccm.2014.29.3.177

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Abstract PDF: BACKGROUND
There has been little data reporting the usefulness of intensivist-performed bedside drainage of pleural effusion via ultrasound (US)-guided pigtail catheter. The objective of this study is to clarify the usefulness and safety of these methods in comparison with radiologist-performed procedures.
METHODS
Data of patients with pleural effusion treated with US-guided pigtail catheter drainage were analyzed. All procedures were performed from September 2012 to September. 2013 by a well-trained intensivist or radiologist.
RESULTS
Pleural effusion was drained in 25 patients in 33 sessions. A radiologist performed 21 sessions, and an intensivist performed 12 sessions. Procedures during mechanical ventilation were performed in 15 (71.4%) patients by a radiologist and in 10 (83.3%) by an intensivist (p = 0.678). The success rate was not significantly different in radiologist- and intensivist-performed procedures, 95.2% (20/21) and 83.3% (10/12), respectively (p = 0.538). The average duration for procedures (including in-hospital transfer) was longer in radiologist-performed cases (p = 0.001). Although the results are limited because of the small population size, aggravation of oxygenation, CO2 retention, and decrease of mean arterial blood pressure were not statistically different in the groups. Pigtail-associated complications including hemothorax, pneumothorax, hepatic perforation, empyema, kink in the catheter, and subcutaneous hematoma were not found.
CONCLUSIONS
Intensivist-performed bedside drainage of pleural effusion via ultrasound (US)-guided pigtail catheter is useful and safe and may be recommended in some patients in an intensive care unit.

Determination of the Cause of Pleural Effusion in ICU Patients with Thoracentesis: Tae Yun Park, Jinwoo Lee, Young Sik Park, Chang Hoon Lee, Jae Joon Yim, Chul Gyu Yoo, Young Whan Kim, Sung Koo Han, Seok Chul Yang, Sang Min Lee; Korean J Crit Care Med. 2012;27(4):249-254.; DOI: https://doi.org/10.4266/kjccm.2012.27.4.249

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Abstract PDF

BACKGROUND
Pleural effusion is a common and important problem in the intensive care unit (ICU). However, only few studies have focused on the etiology of pleural effusion in the ICU. The aim of this study is to elucidate the etiology of pleural effusion in ICU patients in a tertiary care hospital.
METHODS
Patients with pleural effusion in the medical ICU (MICU) and in the emergency ICU (EICU) were studied retrospectively from January 1, 2006 to December 31, 2009. The etiology and profile of pleural effusion were analyzed.
RESULTS
Of 1,592 patients admitted to the MICU and EICU during the study period, 78 patients (4.8%) underwent thoracentesis. The mean age was 66.8 +/- 13.3 years, and 52 (66.7%) were men. Parapneumonic effusion (32/78, 41%) was the leading cause of all effusions; malignancy- and heart failure-related effusions accounted for 15 (19.2%) and 14 (17.7%) cases, respectively. Fifteen patients (19.2%) had tube insertion after thoracentesis; in these patients, parapneumonic effusion or empyema was the most common reason for drainage (9/15, 60%). Pneumothorax developed after thoracentesis in 2 patients.
CONCLUSIONS
Diagnostic thoracentesis was performed in 4.8% of patients admitted to the ICU; one-fifth of these cases required therapeutic drainage. Parapneumonic effusion was the most common cause of pleural effusion in the ICU in this study.

Citations

Citations to this article as recorded by

Prevalence, causes, and clinical implications of pleural effusion in pulmonary ICU and correlation with patient outcomes
Mohamed Farrag, Ahmed El Masry, Amr M. Shoukri, Mona ElSayed
Egyptian Journal of Bronchology.2018; 12(2): 247. CrossRef

Case Reports

Delayed Pleural Effusion after Right Subclavian Vein Catheterization: A Case Report: Ji Ung Kim, Ji Hyun Cheon, Il Soo Kim, Sun Kwang Kim, Sung Hyun Ko, Sea Won Lee, Sang Hee Kim, Su Hong Kim; Korean J Crit Care Med. 2010;25(3):190-193.; DOI: https://doi.org/10.4266/kjccm.2010.25.3.190

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Abstract PDF: Central venous catheterization is commonly used for supplying large amounts of fluids, total parenteral nutrition and for monitoring central venous pressure. Numerous complications exist with the technique, including pneumothorax, arterial puncture with vessel injury, catheter embolus, mediastinal hematoma, hydrothorax, and the thrombus of the vein. We reported an uncommon case of pleural effusion, due to catheter tip migration and penetration, which occurred 4 days after central venous catheterization.

Atelectasis of Dependent Lungs during Fistula Closure in a Patient with Tracheopleural Fistula: A Case Report: Hong Soo Jung, Yeon Soo Jeon, Jin Woo Choi, Jin Deok Joo, Yong Shin Kim, Dae Woo Kim, Jang Hyeok In, Joo Seon Park; Korean J Crit Care Med. 2009;24(2):106-110.; DOI: https://doi.org/10.4266/kjccm.2009.24.2.106

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Abstract PDF: Atelectasis is a fairly common complication in patients undergoing general anesthesia. However, atelectasis caused secretion plugs in patients with tracheopleural fistula is less common than other airway fistulas such as trachea and bronchus. Anesthesiologists should make every effort for thorough preoperative preparation to prevent atelectasis and using appropriate and aggressive treatment, including tracheal or bronchial clearing and end expiratory positive pressure. We report a case of an intraoperative occurrence of atelectasis of the lower lobe of a dependent lung in a patient with a tracheopleural fistula during single lung ventilation for primary closure.

A Case of Respiratory Failure Caused by Gastropleural Fistula: A Case Report: Woo Hyun Cho, Dong Yup Ryu, Sung Yik Lee, Bo Hyun Kim, Yun Seong Kim; Korean J Crit Care Med. 2005;20(2):183-186.

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Abstract PDF: Gastropleural fistula is a very rare disorder, caused by various conditions, such as trauma and postoperative complication, subphrenic abscess, malignancy, hiatal hernia. The major causes of the gastropleural fistula have changed from trauma and subphrenic abscess to postoperative complication of malignant disorders. We report a case of empyema that developed respiratory failure caused by gastropleural fistula in a middle age woman with review of related articles.

Re-expansion Pulmonary Edema after Chest Tubing: A Case Report: Seong Wook Jeong, Chang Mo Kim, Cheol Hun Choi, Dong Jin Shin, Hong Beom Bae, Sung Su Chung, Kyung Yeon Yoo, Chang Young Jeong; Korean J Crit Care Med. 2005;20(1):87-91.

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Abstract PDF: Re-expansion pulmonary edema (RPE) is a rare complication associated with the treatment of collapsed lung caused by pneumothorax, atelectasis, pleural effusion in which a large amount of air or effusion fluid is evacuated. In general RPE is resulted from more than 3 days of lung collapse and application of high negative intrapleural pressure. However, it is reported that RPE could be developed despite the collapse period is short and negative pressure suction is not performed. It also has been known that the rate of reexpansion is more important than amount of evacuated air, or collapse period in the development of RPE. Seventeen-year-old female was undergone suture hemostasis for liver laceration, in which RPE was occurred after closed thoracostomy for pleural effusion on postoperative-27 day. We present a case report with review of related articles.

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