Hu Kurt, Chopra Amit, Kurman Jonathan, Huggins J Terrill
Division of Pulmonary and Critical Care Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
Division of Pulmonary and Critical Care Medicine, Albany Medical College, Albany, NY, USA.
J Thorac Dis. 2021 Aug;13(8):5205-5222. doi: 10.21037/jtd-2021-31.
Disorders of the pleural space are quite common in the critically ill patient. They are generally associated with the underlying illness. It is sometimes difficult to assess for pleural space disorders in the ICU given the instability of some patients. Although the portable chest X-ray remains the primary modality of diagnosis for pleural disorders in the ICU. It can be nonspecific and may miss subtle findings. Ultrasound has become a useful tool to the bedside clinician to aid in diagnosis and management of pleural disease. The majority of pleural space disorders resolve as the patient's illness improves. There remain a few pleural processes that need specific therapies. While uncomplicated parapneumonic effusions do not have their own treatments. Those that progress to become a complex infected pleural space can have its individual complexity in therapy. Chest tube drainage remains the cornerstone in therapy. The use of intrapleural fibrinolytics has decreased the need for surgical referral. A large hemothorax or pneumothorax in patients admitted to the ICU represent medical emergencies and require emergent action. In this review we focus on the management of commonly encountered complex pleural space disorders in critically ill patients such as complicated pleural space infections, hemothoraces and pneumothoraces.
胸膜腔疾病在危重症患者中相当常见。它们通常与基础疾病相关。鉴于一些患者病情不稳定，在重症监护病房（ICU）有时难以评估胸膜腔疾病。尽管便携式胸部X线检查仍是ICU中胸膜疾病的主要诊断方式，但它可能不具有特异性，且可能遗漏细微的发现。超声已成为床边临床医生辅助诊断和管理胸膜疾病的有用工具。随着患者病情改善，大多数胸膜腔疾病会得到缓解。仍有一些胸膜病变需要特定的治疗。虽然单纯性类肺炎性胸腔积液没有其自身的治疗方法，但那些进展为复杂感染性胸膜腔的疾病在治疗上会有其个体复杂性。胸腔闭式引流仍然是治疗的基石。胸膜腔内使用纤维蛋白溶解剂减少了手术转诊的需求。入住ICU的患者出现大量血胸或气胸属于医疗紧急情况，需要紧急处理。在本综述中，我们重点关注危重症患者中常见的复杂胸膜腔疾病的管理，如复杂性胸膜腔感染、血胸和气胸。
