Abstract
Introduction:
In ICU most common cause of pleural effusion (Pl.E) is CHF. However, etiologies of Pl.E vary depending on case mix population. In respiratory cases presence of Pl.E implies serious local or systemic disease. Aim of the study was to determine etiology of Pl.E in RICU
Methodology:
The present study was conducted on 50 consecutive patients detected with Pl.E at the RICU of Metro Centre for Respiratory Diseases, India. Site of aspiration and quantity of pleural fluid (Pl.F) was estimated by USG chest. Chest radiograph, CT chest and USG guided thoracocentesis, with Pl.F analysis(protein,LDH,sugar,TLC,DLC,ADA,BNP,amylase,creat,bilirubin,cholesterol,TG,cytology,HCT)done and if undiagnosed thoracoscopic pleural biopsy was done
Results:
Mean duration of stay in patients developing Pl.E in RICU was 18 days, 5 days more than patients admitted with Pl.E. 30% of the Pl.E were transudate and 16% discordant exudates. Etiology was undetermined in 12%. The most common cause for Pl.E was malignancy(24%); metastatic adenocarcinoma from unknown primary(6%), followed by parapneumonic(22%), CHF(18%) and tuberculosis(14%). Pl.E diagnosed clinically in 30% and 48% on chest X ray. On USG, 70% of Pl.E were quantified as <500 ml, 14% >1000 ml fluid and loculated in 12%. The mean Pl.F BNP was more than 20,000 pg/ml in patients with CHF. Non transudate effusions had normal BNP. Thoracoscopic pleural biopsy established etiology in 90% of undiagnosed Pl.E
Conclusion:
Etiology of Pl.E is different in RICU. Malignant and parapneumonic Pl.E contributing to nearly half of cases. Pl.E had significant implications in management, aggressive approach using thoracoscopic pleural biopsy is needed to confirm diagnosis.
- © 2013 ERS