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Table 1 Summary of studies included in the systematic review

From: Utility and safety of draining pleural effusions in mechanically ventilated patients: a systematic review and meta-analysis

Reference Objective Design Population N Mean Age (SD) Sex N (% Female) Mechanical Ventilation N (%) Intervention
Godwin 1990 [37] Assess safety of thoracentesis in mechanically ventilated patients Multi-centre retrospective cohort Mechanically ventilated patients 29 Range 1 to 88 years (only 1 patient under 25 years) Not reported 29 (100%) Needle aspiration by medical student or resident (84%) or staff intensivist (16%) without imaging guidance
Yu 1992 [47] Evaluate utility of chest ultrasound in diagnosis and management of critically ill patients Single-centre prospective cohort Critically ill patients (not all admitted to ICUa) with unclear findings on chest radiography 41 56 (18) years 10 (24%) 14 (34%) Needle aspiration after puncture site marked using ultrasound guidance (performed in patients with pleural effusion on ultrasound)
McCartney 1993 [41] Evaluate the safety of thoracentesis in mechanically ventilated patients Single-centre prospective cohort Patients on mechanical ventilation with a pleural effusion and a clinical indication for drainage 26 Range 19 to 92 years Not reported 26 (100%) Needle aspiration by staff intensivist; ultrasound employed to mark puncture site in some cases (percentage unknown)
Gervais 1997 [36] Compare pneumothorax rates after thoracentesis between ventilated and spontaneously breathing patients Single-centre retrospective cohort Patients who underwent diagnostic thoracentesis in the interventional radiology suite over a four-year period. Included some pediatric patients. 434 Range 2 to 90 years 184 (42%) 90 (21%) Needle aspiration by resident or fellow under staff supervision after marking puncture site using ultrasound guidance
Guinard 1997 [48] Evaluate the prognostic utility of the physiologic response to a multiple component optimization strategy in ARDSb Single-centre prospective cohort Mechanically ventilated patients with ARDS with a lung injury score >2.5 and severe hypoxemia (mean SAPS IIc46, SD 14) 36 35 (12) years 20 (56%) 36 (100%) Drainage of pleural effusions where present (exact method not specified) along with other maneuvers to optimize gas exchange
Talmor 1998 [35] Measure the effects of pleural fluid drainage on gas exchange and pulmonary mechanics in patients with severe respiratory failure Single-centre prospective cohort Surgical ICU patients on mechanical ventilation with hypoxemia unresponsive to recruitment maneuver (PEEPd20 cm H2O) and pleural effusions on chest radiograph (mean APACHE IIe21, SD 2) 19 68 (4) years Not reported 19 (100%) Large-bore tube thoracostomy without imaging guidance
Lichtenstein 1999 [39] Evaluate the safety of ultrasound-guided thoracentesis in mechanically ventilated patients Single-centre prospective cohort Medical ICU patients on mechanical ventilation with a pleural effusion identified by routine chest ultrasound and a clinical indication for drainage 40 64 years (SD not reported) 22 (55%) 40 (100%) Needle aspiration by staff intensivist marking puncture site using ultrasound guidance
Fartoukh 2002 [4] Assess the impact of routine thoracentesis on diagnosis and management Multi-centre prospective cohort Medical ICU patients (median SAPS II 46, range 30 to 56) 113 59 (range 42 to 68) years 54 (48%) 68 (60%) Needle aspiration without imaging guidance
De Waele 2003 [31] Measure the effect of drainage of pleural effusions on oxygenation Single-centre retrospective cohort Medical-surgical ICU patients (mean APACHE II 21, SD 8) 58 53 (19) years 19 (33%) 24 (41%) Small-bore pigtail catheter insertion (61%) or tube thoracostomy (39%) by staff intensivist without imaging-guidance
Singh 2003 [42] Evaluate the utility and safety of a 16-gauge catheter system for draining pleural effusions Multi-centre prospective cohort ICU patients with a large pleural effusion thought to contribute to respiratory impairment 10 Not reported Not reported 8 (80%) Small-bore catheter insertion without imaging guidance
Ahmed 2004 [33] Measure effects of thoracentesis on hemodynamic and pulmonary physiology Single-centre prospective cohort Mechanically ventilated surgical ICU patients with a pulmonary artery catheter and a large pleural effusion and a clinical indication for drainage (mean APACHE II 17, SD 6) 22 63 (18) years 10 (45%) 22 (100%) Small-bore pigtail catheter inserted under real-time ultrasound guidance
Mayo 2004 [40] Evaluate the safety of ultrasound-guided thoracentesis in mechanically ventilated patients Single-centre prospective cohort Medical ICU patients on mechanical ventilation with a pleural effusion and a clinical indication for drainage 211 Not reported Not reported 211 (100%) Needle aspiration, small-bore pigtail catheter insertion, or large-bore tube thoracostomy by medical housestaff under staff supervision after puncture site marked using ultrasound guidance
Tu 2004 [46] Assess the need for thoracentesis in febrile medical ICU patients and the utility of ultrasonography for diagnosing empyema Single-centre prospective cohort Medical ICU patients with temperature >38°C for at least eight hours and a pleural effusion on chest radiography and ultrasound 94 66 (19) years 39 (41%) 81 (86%) Needle aspiration under real-time ultrasound guidance
Roch 2005 [44] Evaluate the accuracy of ultrasonography to predicting size of pleural effusion Single-centre prospective cohort Medical-surgical ICU patients on mechanical ventilation with a clinical indication for thoracentesis 44 60 (11) 16 (36%) 44 (100%) Large-bore tube thoracostomy without imaging guidance
Vignon 2005 [45] Evaluate the accuracy of ultrasonography to predicting size of pleural effusion Single-centre prospective cohort Medical-surgical ICU patients with suspected pleural effusion based on physical examination or unexplained hypoxemia 116 60 (20) years 41 (35%) 68 (59%) Needle aspiration after puncture site marked using ultrasound guidance
Balik 2006 [43] Assess the utility of ultrasonography to predict pleural effusion size Single-centre prospective cohort Sedated and mechanically ventilated medical ICU patients with a large pleural effusion and a clinical indication for thoracentesis (mean APACHE II 20, SD 7) 81 60 (15) years 34 (42%) 81 (100%) Needle aspiration (84%) or small-bore pigtail catheter insertion (16%) by staff intensivist after marking puncture site using ultrasound guidance
Doelken 2006 [34] Measure the effects of thoracentesis on gas exchange and pulmonary mechanics Single-centre prospective cohort Mechanically ventilated patients with a large pleural effusion and a clinical indication for drainage 8 74 (20) years 5 (63%) 8 (100%) Needle aspiration under real-time ultrasound guidance
Tu 2006 [32] Describe the epidemiology and bacteriology of parapneumonic effusions and empyema in the ICU Single-centre prospective cohort Medical ICU patients with temperature >38°C for at least eight hours and a pleural effusion on chest radiography and ultrasound 175 65 (18) years 65 (37%) 148 (84%) Needle aspiration under real-time ultrasound guidance
Liang 2009 [38] Measure the effectiveness and safety of pigtail catheters for drainage of pleural effusions in the ICU Single-centre retrospective cohort Medical-surgical ICU patients with a pleural effusion who underwent pigtail catheter insertion (mean APACHE II 17, SD 7) 133 64 (15) years 40 (30%) 108 (81%) Small-bore pigtail catheter insertion by staff intensivist after marking puncture site using ultrasound guidance
  1. aICU = intensive care unit.
  2. bARDS = acute respiratory distress syndrome.
  3. cSAPS = Simplified Acute Physiology Score.
  4. dPEEP = positive end-expiratory pressure.
  5. eAPACHE = acute physiology and chronic health evaluation.