Application of ultrasound-guided pigtail catheter for drainage of pleural effusions in the ICU

Shinn-Jye Liang, Chih-Yen Tu, Hung-Jen Chen, Chia-Hung Chen, Wei Chen, Chuen-Ming Shih, Wu-Huei Hsu
Intensive Care Medicine 2009, 35 (2): 350-4

BACKGROUND: Little is known about the effectiveness of the pigtail catheter for drainage of pleural effusions in the intensive care unit (ICU).

METHODS: We conducted a retrospective review of adult patients (>/=18 years) who underwent ultrasound-guided pigtail catheter drainage of pleural effusions in the ICUs from January 2005 to July 2007 in a university hospital.

RESULTS: Among the 133 enrolled patients, there were 93 (70%) males and 40 (30%) females, with a mean age of 63.7 +/- 15.4 years old. The reasons for pigtail drainage were as follows: thoracic empyema (n = 59, 44%), massive transudative pleural effusions (n = 33, 25%), postoperative pleural effusion (n = 29, 15%), malignant pleural effusion (n = 18, 14%) and traumatic hemothorax (n = 3, 2%). In comparing the total amount of fluids drained, the duration of drainage, success rate and complication rate among these different causes of pleural effusion, pigtail drainage for massive transudative pleural effusion yielded the largest amount of pleural fluids (5,382 +/- 4,844 ml), provided the longest duration of drainage (9 +/- 7 days), and had the highest complication rate (18%). The success rate was highest when used to treat traumatic hemothorax (100%) and postoperative pleural effusions (85%); drains inserted for empyema were more likely to fail (overall success rate, 42%). No significant insertion complications, such as hollow organ perforation, were caused by this procedure.

CONCLUSION: The ultrasound-guided pigtail catheter inserted by intensivists is a well-tolerated and effective method of draining all kinds of pleural effusions in critically ill patients. We suggest that pigtail catheter drainage be considered as the initial treatment of choice in the ICU.

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