Safety of Ultrasound-Guided Thoracentesis in Patients Receiving Mechanical Ventilation

doi:10.1378/chest.125.3.1059

Chest

Volume 125, Issue 3, March 2004, Pages 1059-1062

https://doi.org/10.1378/chest.125.3.1059 Get rights and content

Objective

To determine the safety of ultrasound-guided thoracentesis (UST) performed by critical care physicians on patients receiving mechanical ventilation.

Design

Prospective and observational.

Setting

ICUs in a teaching hospital.

Patients

Two hundred eleven serial patients receiving mechanical ventilation with pleural effusion requiring diagnostic or therapeutic thoracentesis.

Interventions

Two hundred thirty-two separate USTs were performed by critical care physicians without radiology support. Anteroposterior chest radiographs were reviewed for possible postprocedure pneumothorax.

Results

Pneumothorax occurred in 3 of 232 USTs (1.3%). The procedure was well tolerated in this critically ill population.

Conclusions

UST performed in patients receiving mechanical ventilation without radiology support results in an acceptable rate of pneumothorax.

Section snippets

Materials and Methods

Between August 1995 and December 1998, we prospectively collected data on 232 consecutive thoracenteses performed under ultrasound guidance on patients requiring mechanical ventilation in the medical ICUs of Beth Israel Medical Center, New York City. All patients were tracheally intubated and receiving mechanical ventilation (Puritan Bennett 7200; Puritan Bennett; Carlsbad, CA) at the time of the procedure. The decision to perform the thoracentesis was made on clinical grounds alone and was not

Results

In total, 232 separate thoracenteses were performed on 211 patients. Three thoracenteses yielded no fluid (1.3%). Results are reported as mean ± SD. Of the 232 thoracenteses, 222 thoracenteses (95.6%) were performed with patients receiving PEEP at 6.8 ± 2 cm/H₂O, and 148 thoracenteses (63%) with vasopressor therapy. The Pao₂/fraction of inspired oxygen was 178 ± 38. We performed 90 thoracenteses (38.8%) whose primary purpose was diagnostic, removing 90 ± 31mL of fluid. We performed 142

Discussion

Our study demonstrates that UST results in a low and acceptable rate of pneumothorax based on the objective data presented. The safety of thoracentesis in patients receiving mechanical ventilation has been investigated previously. Gervais et al⁹ reported a case series including 92 patients receiving mechanical ventilation who underwent UST, resulting in pneumothorax in 6 patients (6.5%). The procedures were performed in a radiology suite by radiologists. Our pneumothorax rate of 1.3% compares

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: This study was supported by the Dina and Rafael Recanati Research Fund.

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Clinical Investigations in Critical CareSafety of Ultrasound-Guided Thoracentesis in Patients Receiving Mechanical Ventilation

Objective

Design

Setting

Patients

Interventions

Results

Conclusions

Section snippets

Materials and Methods

Results

Discussion

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Mayo Clin Proc

Clinical Investigations in Critical Care
Safety of Ultrasound-Guided Thoracentesis in Patients Receiving Mechanical Ventilation