Ultrasound-Guided Pleural Effusion Drainage: Effect on Oxygenation, Respiratory Mechanics, and Liberation from Mechanical Ventilation in Surgical Intensive Care Unit Patients
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Patients
2.2. Mechanical Ventilation, Pleural Drainage, and Physiological Measurement
2.3. Data Collection and Statistical Analysis
3. Results
3.1. Patient Characteristics
3.2. Procedural Outcomes
3.3. Changes in Arterial Blood Gas Parameters and Respiratory Mechanics before and after the Procedure
3.4. Frequency and Predictors of Freedom from Mechanical Ventilation within the First 72 Post-Procedural Hours
3.5. Subgroup Analyses According to the Time Interval from Surgery to Pleural Effusion Drainage
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Total Patients | |
---|---|
(n = 62) | |
Age (years) | 61.4 ± 13.4 |
Sex (Men/women) | 44/18 |
Body mass index (kg/m2) | 24.1 ± 4.2 |
Opeartion type | |
Cardiovascular or thoracic | 22 (35.5%) |
Abdomen | 32 (51.6%) |
Burn | 2 (3.2%) |
Brain | 1 (1.6%) |
Limbs | 3 (4.8%) |
Neck | 2 (3.2%) |
Side | |
Left | 22 (35.5%) |
Right | 37 (59.7%) |
Bilateral | 3 (4.8%) |
SOFA score | 8.4 ± 3.8 |
Laboratory parameters | |
White blood cells (1000/μL) | 12.9 ± 6.5 |
Platelets (1000/μL) | 160 ± 119 |
Prothrombin time/international normalized ratio | 1.2 ± 0.4 |
Total bilirubin (mg/dL) | 4.1 ± 6.5 |
Creatinine (mg/dL) | 2.2 ± 2.3 |
Arterial blood gas analysis before pleural effusion drainage | |
PaO2/FiO2 ratio (mmHg) | 280 ± 102 |
PaCO2 (mmHg) | 38 ± 7 |
pH | 7.4 ± 0.1 |
Ventilator settings before pleural effusion drainage | |
Peak airway pressure (cmH2O) | 23 ± 5 |
Positive end expiratory pressure (cmH2O) | 8 ± 1 |
Tidal volume/predicted body weight (mL/Kg) | 9 ± 2 |
Respiratory rate (/minute) | 19 ± 4 |
Dynamic driving pressure (cmH2O) | 14 ± 5 |
Dynamic lung compliance (mL/cmH2O) | 40 ± 18 |
Time interval from operation to the onset of pleural effusion (days) | 9 ± 11 |
Time interval from the onset of pleural effusion to pleural effusion drainage (days) | 1.7 ± 1.8 |
Chest ultrasound findings | |
Fluid height (number of intercostal spaces) | 3.5 ± 1.3 |
Fluid depth (cm) | 4.3 ± 1.6 |
Inadequate diaphragm movements | 10 (16.1%) |
Drainage volume (mL) | |
During the first day | 864 ± 493 |
Average per day | 233 ± 168 |
T −1 | T 0 | T +1 | p Value (T −1 vs. T 0) | p Value (T 0 vs. T +1) | |
---|---|---|---|---|---|
PaO2/FiO2 ratio (mmHg) | 300 ± 146 | 280 ± 102 | 319 ± 101 | 0.92 | 0.002 * |
PaCO2 (mmHg) | 38 ± 6 | 38 ± 7 | 37 ± 7 | 0.79 | 0.14 |
pH | 7 ± 0.1 | 7 ± 0.1 | 7 ± 0.1 | 0.42 | 0.13 |
Peak airway pressure (cmH2O) | 23 ± 5 | 23 ± 5 | 22 ± 6 | 0.13 | 0.01 * |
Positive end expiratory pressure (cmH2O) | 9 ± 1 | 8 ± 1 | 8 ± 1 | 0.78 | 0.74 |
Tidal volume/predict body weight (mL/Kg) | 9 ± 2 | 9 ± 2 | 9 ± 2 | 0.20 | 0.35 |
Respiratory rate (per min) | 18 ± 4 | 18 ± 4 | 18 ± 4 | 0.59 | 0.26 |
Dynamic driving pressure (cmH2O) | 15 ± 4 | 14 ± 5 | 13 ± 5 | 0.10 | 0.008 * |
Dynamic lung compliance (mL/cmH2O) | 37 ± 12 | 40 ± 18 | 46 ± 21 | 0.22 | 0.003 * |
Univariate Analysis | Multivariable Analysis | |||
---|---|---|---|---|
Odds Ratio (95% CI) | p | Odds Ratio (95% CI) | p | |
Sex | ||||
Woman | 1 (reference) | |||
Man | 0.8 (0.3–2.6) | 0.75 | ||
Age, per 1 year increment | 1.01 (0.97–1.05) | 0.51 | ||
Body mass index, per 1 kg/m2 increament | 1.08 (0.95–1.23) | 0.22 | ||
Operation type | ||||
Cardiovascular or thoracic | 1 (reference) | 1 (reference) | ||
Others | 3.00 (1.02–8.80) | 0.046 * | 4.97 (1.03–24.04) | 0.046 * |
SOFA score, per 1 increment | 1.09 (0.95–1.25) | 0.24 | ||
Time interval from operation to the onset of pleural effusion, per 1 day increment | 1.10 (1.02–1.19) | 0.013 * | 1.16 (1.05–1.30) | 0.005 * |
Time interval from the onset of pleural effusion to pleural effusion drainage, per 1 day increment | 1.5 (0.90–1.74) | 0.19 | ||
Average pleural effusion drainage volume per day, per 1 mL increament | 0.999 (0.996–1.002) | 0.63 | ||
Laboratory parameters | ||||
PT/INR, per 1 increament | 1.08 (0.28–4.19) | 0.91 | ||
Blood gas analyses and respiratory mechanics before pleural effusion drainage | ||||
Positive end expiratory pressure, per 1 cm H2O increment | 1.47 (0.97–2.23) | 0.07 | 1.36 (0.65–2.86) | 0.42 |
Peak airway pressure, per 1 cm H2O increment | 1.17 (1.05–1.31) | 0.004 * | 1.30 (1.07–1.59) | 0.009 * |
Inadequate diaphragm movements | ||||
No | 1 (reference) | 1 (reference) | ||
Yes | 8.33 (0.98–70.57) | 0.05 | 13.44 (0.59–304.68) | 0.10 |
≤6 Days (n = 36) | >6 Days (n = 26) | |||||
---|---|---|---|---|---|---|
T 0 | T +1 | p Value | T 0 | T +1 | p Value | |
PaO2/FiO2 ratio (mmHg) | 278 ± 122 | 338 ± 118 | 0.006 * | 281 ± 79 | 296 ± 71 | 0.22 |
PaCO2 (mmHg) | 39 ± 8 | 36 ± 7 | 0.07 | 38 ± 5 | 38 ± 7 | 0.46 |
pH | 7 ± 0.1 | 7 ± 0.1 | 0.04 * | 7 ± 0.1 | 7 ± 0.1 | 0.32 |
Peak airway pressure (cmH2O) | 23 ± 5 | 21 ± 5 | 0.002 * | 23 ± 6 | 22 ± 7 | 0.81 |
Positive end expiratory pressure (cmH2O) | 8 ± 1 | 8 ± 1 | 0.66 | 9 ± 2 | 9 ± 2 | >0.99 |
Tidal volume/predict body weight (mL/Kg) | 9 ± 2 | 9 ± 2 | 0.80 | 9 ± 1 | 9 ± 1 | 0.26 |
Respiratory rate (per min) | 19 ± 5 | 17 ± 3 | 0.04 * | 18 ± 3 | 19 ± 5 | 0.51 |
Dynamic driving pressure (cmH2O) | 15 ± 5 | 13 ± 4 | 0.002 * | 14 ± 5 | 14 ± 6 | 0.81 |
Dynamic lung compliance (mL/ cmH2O) | 39 ± 18 | 46 ± 21 | 0.007 * | 41 ± 18 | 47 ± 22 | 0.17 |
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Fang, H.-Y.; Chang, K.-W.; Chao, Y.-K. Ultrasound-Guided Pleural Effusion Drainage: Effect on Oxygenation, Respiratory Mechanics, and Liberation from Mechanical Ventilation in Surgical Intensive Care Unit Patients. Diagnostics 2021, 11, 2000. https://doi.org/10.3390/diagnostics11112000
Fang H-Y, Chang K-W, Chao Y-K. Ultrasound-Guided Pleural Effusion Drainage: Effect on Oxygenation, Respiratory Mechanics, and Liberation from Mechanical Ventilation in Surgical Intensive Care Unit Patients. Diagnostics. 2021; 11(11):2000. https://doi.org/10.3390/diagnostics11112000
Chicago/Turabian StyleFang, Hsin-Yueh, Ko-Wei Chang, and Yin-Kai Chao. 2021. "Ultrasound-Guided Pleural Effusion Drainage: Effect on Oxygenation, Respiratory Mechanics, and Liberation from Mechanical Ventilation in Surgical Intensive Care Unit Patients" Diagnostics 11, no. 11: 2000. https://doi.org/10.3390/diagnostics11112000