Table 1.
Summary of studies included in the systematic review
| Reference | Objective | Design | Population | N | Mean Age (SD) | Sex N (% Female) | Mechanical Ventilation N (%) | Intervention |
|---|---|---|---|---|---|---|---|---|
| Godwin 1990 [37] | Assess safety of thoracentesis in mechanically ventilated patients | Multi-centre retrospective cohort | Mechanically ventilated patients | 29 | Range 1 to 88 years (only 1 patient under 25 years) | Not reported | 29 (100%) | Needle aspiration by medical student or resident (84%) or staff intensivist (16%) without imaging guidance |
| Yu 1992 [47] | Evaluate utility of chest ultrasound in diagnosis and management of critically ill patients | Single-centre prospective cohort | Critically ill patients (not all admitted to ICUa) with unclear findings on chest radiography | 41 | 56 (18) years | 10 (24%) | 14 (34%) | Needle aspiration after puncture site marked using ultrasound guidance (performed in patients with pleural effusion on ultrasound) |
| McCartney 1993 [41] | Evaluate the safety of thoracentesis in mechanically ventilated patients | Single-centre prospective cohort | Patients on mechanical ventilation with a pleural effusion and a clinical indication for drainage | 26 | Range 19 to 92 years | Not reported | 26 (100%) | Needle aspiration by staff intensivist; ultrasound employed to mark puncture site in some cases (percentage unknown) |
| Gervais 1997 [36] | Compare pneumothorax rates after thoracentesis between ventilated and spontaneously breathing patients | Single-centre retrospective cohort | Patients who underwent diagnostic thoracentesis in the interventional radiology suite over a four-year period. Included some pediatric patients. | 434 | Range 2 to 90 years | 184 (42%) | 90 (21%) | Needle aspiration by resident or fellow under staff supervision after marking puncture site using ultrasound guidance |
| Guinard 1997 [48] | Evaluate the prognostic utility of the physiologic response to a multiple component optimization strategy in ARDSb | Single-centre prospective cohort | Mechanically ventilated patients with ARDS with a lung injury score >2.5 and severe hypoxemia (mean SAPS IIc 46, SD 14) | 36 | 35 (12) years | 20 (56%) | 36 (100%) | Drainage of pleural effusions where present (exact method not specified) along with other maneuvers to optimize gas exchange |
| Talmor 1998 [35] | Measure the effects of pleural fluid drainage on gas exchange and pulmonary mechanics in patients with severe respiratory failure | Single-centre prospective cohort | Surgical ICU patients on mechanical ventilation with hypoxemia unresponsive to recruitment maneuver (PEEPd 20 cm H2O) and pleural effusions on chest radiograph (mean APACHE IIe 21, SD 2) | 19 | 68 (4) years | Not reported | 19 (100%) | Large-bore tube thoracostomy without imaging guidance |
| Lichtenstein 1999 [39] | Evaluate the safety of ultrasound-guided thoracentesis in mechanically ventilated patients | Single-centre prospective cohort | Medical ICU patients on mechanical ventilation with a pleural effusion identified by routine chest ultrasound and a clinical indication for drainage | 40 | 64 years (SD not reported) | 22 (55%) | 40 (100%) | Needle aspiration by staff intensivist marking puncture site using ultrasound guidance |
| Fartoukh 2002 [4] | Assess the impact of routine thoracentesis on diagnosis and management | Multi-centre prospective cohort | Medical ICU patients (median SAPS II 46, range 30 to 56) | 113 | 59 (range 42 to 68) years | 54 (48%) | 68 (60%) | Needle aspiration without imaging guidance |
| De Waele 2003 [31] | Measure the effect of drainage of pleural effusions on oxygenation | Single-centre retrospective cohort | Medical-surgical ICU patients (mean APACHE II 21, SD 8) | 58 | 53 (19) years | 19 (33%) | 24 (41%) | Small-bore pigtail catheter insertion (61%) or tube thoracostomy (39%) by staff intensivist without imaging-guidance |
| Singh 2003 [42] | Evaluate the utility and safety of a 16-gauge catheter system for draining pleural effusions | Multi-centre prospective cohort | ICU patients with a large pleural effusion thought to contribute to respiratory impairment | 10 | Not reported | Not reported | 8 (80%) | Small-bore catheter insertion without imaging guidance |
| Ahmed 2004 [33] | Measure effects of thoracentesis on hemodynamic and pulmonary physiology | Single-centre prospective cohort | Mechanically ventilated surgical ICU patients with a pulmonary artery catheter and a large pleural effusion and a clinical indication for drainage (mean APACHE II 17, SD 6) | 22 | 63 (18) years | 10 (45%) | 22 (100%) | Small-bore pigtail catheter inserted under real-time ultrasound guidance |
| Mayo 2004 [40] | Evaluate the safety of ultrasound-guided thoracentesis in mechanically ventilated patients | Single-centre prospective cohort | Medical ICU patients on mechanical ventilation with a pleural effusion and a clinical indication for drainage | 211 | Not reported | Not reported | 211 (100%) | Needle aspiration, small-bore pigtail catheter insertion, or large-bore tube thoracostomy by medical housestaff under staff supervision after puncture site marked using ultrasound guidance |
| Tu 2004 [46] | Assess the need for thoracentesis in febrile medical ICU patients and the utility of ultrasonography for diagnosing empyema | Single-centre prospective cohort | Medical ICU patients with temperature >38°C for at least eight hours and a pleural effusion on chest radiography and ultrasound | 94 | 66 (19) years | 39 (41%) | 81 (86%) | Needle aspiration under real-time ultrasound guidance |
| Roch 2005 [44] | Evaluate the accuracy of ultrasonography to predicting size of pleural effusion | Single-centre prospective cohort | Medical-surgical ICU patients on mechanical ventilation with a clinical indication for thoracentesis | 44 | 60 (11) | 16 (36%) | 44 (100%) | Large-bore tube thoracostomy without imaging guidance |
| Vignon 2005 [45] | Evaluate the accuracy of ultrasonography to predicting size of pleural effusion | Single-centre prospective cohort | Medical-surgical ICU patients with suspected pleural effusion based on physical examination or unexplained hypoxemia | 116 | 60 (20) years | 41 (35%) | 68 (59%) | Needle aspiration after puncture site marked using ultrasound guidance |
| Balik 2006 [43] | Assess the utility of ultrasonography to predict pleural effusion size | Single-centre prospective cohort | Sedated and mechanically ventilated medical ICU patients with a large pleural effusion and a clinical indication for thoracentesis (mean APACHE II 20, SD 7) | 81 | 60 (15) years | 34 (42%) | 81 (100%) | Needle aspiration (84%) or small-bore pigtail catheter insertion (16%) by staff intensivist after marking puncture site using ultrasound guidance |
| Doelken 2006 [34] | Measure the effects of thoracentesis on gas exchange and pulmonary mechanics | Single-centre prospective cohort | Mechanically ventilated patients with a large pleural effusion and a clinical indication for drainage | 8 | 74 (20) years | 5 (63%) | 8 (100%) | Needle aspiration under real-time ultrasound guidance |
| Tu 2006 [32] | Describe the epidemiology and bacteriology of parapneumonic effusions and empyema in the ICU | Single-centre prospective cohort | Medical ICU patients with temperature >38°C for at least eight hours and a pleural effusion on chest radiography and ultrasound | 175 | 65 (18) years | 65 (37%) | 148 (84%) | Needle aspiration under real-time ultrasound guidance |
| Liang 2009 [38] | Measure the effectiveness and safety of pigtail catheters for drainage of pleural effusions in the ICU | Single-centre retrospective cohort | Medical-surgical ICU patients with a pleural effusion who underwent pigtail catheter insertion (mean APACHE II 17, SD 7) | 133 | 64 (15) years | 40 (30%) | 108 (81%) | Small-bore pigtail catheter insertion by staff intensivist after marking puncture site using ultrasound guidance |
aICU = intensive care unit.
bARDS = acute respiratory distress syndrome.
cSAPS = Simplified Acute Physiology Score.
dPEEP = positive end-expiratory pressure.
eAPACHE = acute physiology and chronic health evaluation.