Bediwy Adel Salah, Al-Biltagi Mohammed, Saeed Nermin Kamal, Bediwy Hosameldin A, Elbeltagi Reem
Department of Chest Diseases, Faculty of Medicine, Tanta University, Tanta 31527, Algharbia, Egypt.
Department of Chest Diseases, University Medical Center, Arabian Gulf University, Dr. Sulaiman Al Habib Medical Group, Manama 26671, Bahrain.
World J Clin Cases. 2023 Feb 16;11(5):989-999. doi: 10.12998/wjcc.v11.i5.989.
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.
胸腔积液通常会导致诊断难题，鉴别诊断的清单很长。许多研究发现，重症和机械通气患者中胸腔积液的患病率很高，在一些研究中，患病率高达50%-60%，范围广泛。本综述强调了在重症监护病房（ICU）住院患者中胸腔积液诊断和管理的重要性。导致胸腔积液的原发病可能正是入住ICU的确切原因。重症和机械通气患者的胸腔液体周转和循环存在障碍。在ICU中诊断胸腔积液也有许多困难，包括临床、放射学甚至实验室方面的困难。这些困难是由于表现不寻常、无法进行某些诊断程序以及一些已执行测试的结果不一致所致。胸腔积液会影响患者的转归和预后，因为这些患者通常有多种合并症，会出现血流动力学和肺力学改变。同样，胸腔积液引流可以改变入住ICU患者的转归。最后，胸腔积液分析在某些情况下可以改变原诊断，并将治疗导向不同的方向。
