Fang Hsin-Yueh, Chang Ko-Wei, Chao Yin-Kai
Division of Thoracic Surgery, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan.
Department of Thoracic Medicine, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan.
Diagnostics (Basel). 2021 Oct 28;11(11):2000. doi: 10.3390/diagnostics11112000.
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/FiO ratio and lung compliance improved after drainage. Additionally, 41.9% ( = 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, = 0.046), a longer time interval from operation to the onset of pleural effusion (OR = 1.165, = 0.005), and a higher peak airway pressure (OR = 1.303, = 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/FiO ratio, PaCO, 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.
对于积极处理术后胸腔积液是否能改善大手术后的临床结局这一问题，目前尚无定论。本研究的目的是探讨超声引导下胸腔积液引流对外科重症监护病房患者氧合、呼吸力学及机械通气脱机的影响。在引流前后测量氧合和呼吸力学指标。在18个月的时间里，共分析了62例患者。前24小时的平均引流量为864±493毫升，且无操作并发症。引流后平均动脉血氧分压/吸入氧浓度比值和肺顺应性均有所改善。此外，41.9%（n = 26）的患者在引流后72小时内脱机。多变量逻辑回归分析显示，非心血管或胸外科手术（比值比[OR]=4.968，P = 0.046）、手术至胸腔积液出现的时间间隔较长（OR = 1.165，P = 0.005）以及较高的气道峰压（OR = 1.303，P = 0.009）是引流后72小时内无法脱机的独立不良预测因素。具体而言，手术至胸腔积液出现时间≤6天的患者——而非间隔>6天的患者——在动脉血氧分压/吸入氧浓度比值、动脉血二氧化碳分压、气道峰压和动态肺顺应性方面术后有显著改善。总之，超声引导下胸腔积液引流对大手术后机械通气的重症监护病房患者有显著的临床益处——尤其是对接受胸外科手术且出现早期胸腔积液的患者。
