Pleural effusion: in medical ITU patients heart failure was a common cause.

Clinical bottom line (level 4)

  1. Pleural effusions were common in patients on medical ITU (~60%)
  2. The commonest causes were heart failure, atelectasis or parapneumonic infection.
  3. Malignancy was rare.
Mattison et al: Chest 1997; 111 (4): 1018-1023
Expires October 2003

The study

Case series with objective outcomes, not adjusted for confounding factors, not validated in an independent set of patients.

Setting: medical intensive care unit, university hospital, USA

100 patients (aged mean 51 years, 59% female) admitted to ITU for diverse reasons (none with primary pleural disease)

Excluded if
  • if stay was 24 hours or less
  • readmitted within 30 days of discharge from ITU





    • Outcomes studied:
  • pleural effusion on admission or during stay
  • cause of pleural effusion: heart failure clinical features, chest x-ray, transudative fluid
  • atelectasis
  • parapneumonic infection clinical features, chest x-ray, bacterial culture
  • hepatic hydrothorax liver failure with documented ascites
  • hypoalbuminaemia
  • other pancreatitis, extravascular catheter migration, uremic pleurisy, empyema
  • malignancy cytology
  • unknown

    • The evidence

    outcome time to outcome number of patients/total number %
    (95% CI)
    pleural effusion on admission or during stay ? 62/100 62%
    (52% to 72%)
    cause of pleural effusion: heart failure ? 22/62 35%
    (24% to 47%)
    atelectasis ? 14/62 23%
    (12% to 33%)
    parapneumonic infection ? 7/62 11%
    (3.4% to 19%)
    hepatic hydrothorax ? 5/62 8.1%
    (1.3% to 15%)
    hypoalbuminaemia ? 5/62 8.1%
    (1.3% to 15%)
    other ? 4/62 6.5%
    (0.3% to 13%)
    malignancy ? 2/62 3.2%
    (0.0% to 7.6%)
    unknown ? 3/62 4.8%
    (0.0% to 10%)

    Citation

    1. Mattison LE, Coppage L, Alderman DF, et al: pleural effusion in the medical ICU: prevalence, causes and clinical implications. Chest 1997; 111 (4): 1018-1023
    Contributor: Chris Ball and Clare Wotton, October 2000
    Reviewer:

    Clinical Question.
    Patient medical ITU
    Intervention or Exposure prevalence
    Outcome pleural effusion