Evaluation of Routine Thoracentesis in Changing the First Diagnosis and Care of Clinically Definite Pleural Effusion in a Medical Intensive Care Unit


Background: Considering the importance of rapid and definite diagnosis and care of ICU admitted patients with clinically documented pleural effusion, this study was conducted to evaluate the effects of thoracentesis in changing the first diagnosis and care of pleural effusion. Materials and Methods: In this prospective study, of those who were admitted to ICU, 30 patients with physical and radiographic evidence of pleural effusion, without having contraindications to thoracentesis, were selected and routine thoracentesis was done. Biochemical, cytological, and microbiological tests were performed. Results: There were 12(40%) male and 18 (60%) female with the mean age of 65.6±17.8 years. Among the reasons for MICU admission, hypoxic respiratory failure is the most common cause (21 patients, 70%), and other causes were “Acute on Chronic Respiratory Failure” (ACRF) in 6 patients (20%). The obtained effusion was transudate in 19 patients (63.3%), a noninfectious exudate in 7 patients (23.3%), and an infectious exudate in 4 patients (13.3%). There were significant differences between the diagnosis made before and after thoracentesis in 17 patients, 56.7% (p < 0.05). In 13 patients (43.3%), definite diagnosis after thoracentesis was the same. Also, in 16 patients (53.3%) based on thoracentesis finding the treatment plan was changed (p <0.05). Conclusion: We concluded that thoracentesis should be performed routinely in ICU patients having pleural effusion. This safe and cheap procedure may provide large gains in diagnosis, treatment, and even prognosis. (Tanaffos 2003; 2(7): 17-23)