Evaluation of the effect of the quality and quantity of fluid drained due to pleural effusion on complications that may develop in intensive care unit

Abstract

Aims: Pleural drainage volume is very important for oxygenation and perfusion in patients with massive pleural effusion. However, there is still no clear data between the complications that may develop after pleural drainage and the optimal volume of fluid to be removed. The primary aim of this study was to evaluate the effect of the quality and quantity of pleural fluid drained due to pleural effusion in the intensive care unit (ICU) on the complications that may develop after drainage and to determine the optimal drainage volume to prevent complications. The secondary aim was to determine the risk factors affecting the development of complications after pleural effusion drainage. Methods: A total of 176 patients who underwent pleural drainage for pleural effusion between April 1,2022 and December 31,2023 in an adult tertiary ICU were retrospectively analyzed. Demographic information, clinical follow-up information, quantity and quality of pleural effusion, laboratory values and complications were recorded and the relationship between these parameters and the amount of pleural fluid drained within 24 hours and complications were evaluated. Results: ICU duration, ICU mortality, activated partial thromboplastin time (aPTT) and vasopressor requirement were found to be statistically significantly higher in patients with complications after pleural drainage procedure.  In multivariate logistic regression analysis, female gender (odds ratio=0.455, p=0.049) and need for vasopressors (odds ratio=2.373, p=0.034) increased the risk of complications. There was no statistically significant difference between the amount of pleural fluid drained and complications. In addition, when the optimal amount of drained fluid required to prevent complications was analyzed, a cut off value could not be given. Conclusion: In order to reduce the risk of complications that may develop after pleural drainage, we believe that paying more attention to the position during pleural drainage in patients receiving vasopressor support and performing pleural drainage with the help of ultrasound in patients whose position cannot be changed due to hemodynamic disorder will reduce the complication rate. We think that a decrease in the complication rate will be effective in terms of both cost and efficient use of ICU beds by reducing the length of ICU stay and ICU mortality. In our study, the quality and quantity of pleural fluid drained had no effect on the complications that may develop after drainage, and further studies with a larger patient population are needed to investigate this situation.