Intensive Care Unit, Royal Berkshire Hospital, Reading Intensive Care Unit, John Radcliffe Hospital, Oxford Adult Intensive Care Unit, University Hospital of Wales, Cardiff, UK.
Respirology. 2013 Feb;18(2):246-54. doi: 10.1111/j.1440-1843.2012.02279.x.
Despite 50-60% of intensive care patients demonstrating evidence of pleural effusions, there has been little emphasis placed on the role of effusions in the aetiology of weaning failure. Critical illness and mechanical ventilation lead to multiple perturbations of the normal physiological processes regulating pleural fluid homeostasis, and consequently, failure of normal pleural function occurs. Effusions can lead to deleterious effects on respiratory mechanics and gas exchange, and when extensive, may lead to haemodynamic compromise. The widespread availability of bedside ultrasound has not only facilitated earlier detection of pleural effusions but also safer fluid sampling and drainage. In the majority of patients, pleural drainage leads to improvements in lung function, with data from spontaneously breathing individuals demonstrating a consistent symptomatic improvement, while a meta-analysis in critically ill patients shows an improvement in oxygenation. The effects on respiratory mechanics are less clear, possibly reflecting heterogeneity of underlying pathology. Limited data on clinical outcome from pleural fluid drainage exist; however, it appears to be a safe procedure with a low risk of major complications. The current level of evidence would support a clinical trial to determine whether the systematic detection and drainage of pleural effusions improve clinical outcomes.
尽管 50-60%的重症监护患者有胸腔积液的证据，但胸腔积液在脱机失败病因中的作用却很少受到重视。危重病和机械通气导致调节胸腔液动态平衡的正常生理过程发生多种紊乱，因此正常的胸腔功能发生衰竭。胸腔积液可导致呼吸力学和气体交换的有害影响，当胸腔积液广泛时，可能导致血液动力学受损。床边超声的广泛应用不仅促进了胸腔积液的早期发现，而且还实现了更安全的液体取样和引流。在大多数患者中，胸腔引流可改善肺功能，自主呼吸患者的数据显示出一致的症状改善，而危重病患者的荟萃分析显示氧合改善。对呼吸力学的影响不太明确，这可能反映了潜在病理的异质性。关于胸腔积液引流的临床结局的有限数据表明，这似乎是一种安全的操作，主要并发症的风险较低。目前的证据水平支持进行一项临床试验，以确定系统性检测和引流胸腔积液是否能改善临床结局。
