الفهرس 
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Abstract
Summary
Pleural effusion is common in critically ill patients, most effusions in intensive care unit (ICU) patients are of limited clinical significance; however, some are important and require aggressive management (David et al., 2011).
Pleural effusion in medical ICU (MICU) patients usually caused by pulmonary or extrapulmonary disorders, rather than by primary pleural diseases (Fartoukh et al., 2002).
Detection of small pleural effusion is problematic in critically ill patients admitted to ICU (Wiener et at., 1991). Chest ultrasonography is a portable, low-cost, radiation-free method, showed consistently high sensitivity, specificity and accuracy in detecting fluid in the pleural space, in different populations and clinical settings (Alexandre et al., 2010).
Aim of the work:
The current study aimed to determine the prevalence, causes, methods of assessment of pleural effusion in pulmonary ICU patients, different management strategies and their impact on the patient outcomes.
Subjects and methods:
This study recruited ninety patients admitted to pulmonary ICU in Abbaseia Chest Hospital either with pleural effusion or developed effusion during ICU stay over a period of one year from January 2016 to January 2017.
All patients were subjected to full history taking, thorough clinical examination, diagnostic chest x-ray, chest Ultrasonography, with/without CT scan, Echocardiography or CT Chest with pulmonary angiography whenever possible, collection of data concerning different management strategies and their effect on patient outcome.
Results:
In the current study, pleural effusion was prevalent in 12.7% (90 out of 740 patients totally admitted to ICU during one year).
The most common cause of ICU admission in patients with pleural effusion was severe pneumonia (42.2%) followed by acute exacerbation of COPD (20%).
In the current study, it was found that among the studied group 83 patients (92.2%) had pleural effusion at time of ICU admission, while only 7 patients (7.7%) developed pleural effusion during ICU stay.
Chest x ray detected pleural effusion in only 74 patients (82.2%). Mild pleural effusion was the most commonly found in chest x ray in (46%) followed by moderate effusion in (25.5%), while massive effusion was the least found in (10%) of patients.
The most common concomitant radiological finding seen in chest x ray in the current study was heterogeneous opacity consistent with pneumonic patch in 23 patients (25.5%).
Complex non septated effusion was the most commonly detected ultrasonographic pattern in (41%) of patients followed by simple effusion in (40%) of patients.
U/S was significantly superior to CXR in detecting pleural effusion, as it was able to detect pleural effusion in all
patients. While CXR detected pleural effusion in 74 patients (82.2%) .
Thoracentesis-based (final) cause of pleural effusion was different from provisional cause in 17 patients (25.7%).
Exudative effusion formed (77.7%) of causes of pleural effusion in ICU, while transudative effusion formed (22.2%).
Uncomplicated parapneumonic effusion was the most common cause of pleural effusion (36.7%), followed by heart failure (17.8%). Infectious exudate including uncomplicated parapneumonic effusion and empyema forming (52.2%) of causes of pleural effusion. Malignant pleural effusion was the second most common cause of exudative pleural effusion (16.7%).
The most common cause of pleural effusion developed during ICU stay was uncomplicated parapneumonic effusion.
The cause of pleural effusion didn’t significantly affect the patient outcome or duration of ICU stay.
In the present study, therapeutic aspiration was done for 23 patients (25.6%). It was mainly indicated in malignant effusion in 11 patients (47.8%) to improve patient dyspnea. Also it was done for 4 (17.3%) patients with parapneumonic effusion. Drainage was done for 20 (22.2%) patients. The main indication for drainage in these patients was empyema in 11 patients followed by malignancy in 4 patients.
Hydropneumothorax and surgical emphysema occurred in 3 patients (4%) after chest tube drainage. While no complications reported with ultrasound guided aspiration.
There was no significant reduction in duration of ICU stay or ICU mortality in patients who received therapeutic aspiration or tube drainage compared to patients received no specific management for effusion.