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Little is known about the effectiveness of the pigtail catheter for drainage of pleural effusions in the intensive care unit (ICU). 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. 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. 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. [ABSTRACT FROM AUTHOR]

Objectives: To assess the incidence, pathogens, and outcome of complicated parapneumonic effusions or empyemas in a medical intensive care unit (MICU) patients with pleural effusions. Design and setting: Prospective study of febrile MICU patients with pleural effusion carried out in a tertiary care hospital between April 2001 and September 2003. Patients: The study included 175 patients with a temperature above 38° for more than 8 h with evidence of pleural effusion confirmed by chest radiography and ultrasound. Intervention: Routine thoracentesis and effusion cultures. Results: The prevalence of complicated parapneumonic effusions or thoracic empyemas in febrile MICU patients with pleural effusions was 45% (78/175). A total of 78 micro-organisms were isolated from the pleural fluid of 58 patients (positive microbiological culture 74%) including aerobic Gram-negative (n = 45), aerobic Gram-positive (n = 23), anaerobic (n = 5), Myobacterium tuberculosis (n = 3), and Candida (n = 2). The infection-related mortality rate of complicated parapneumonic effusions or empyemic patients in the MICU was 41% (32/78). Conclusion: The development of complicated parapneumonic effusions or thoracic empyemas in MICU patients is a high-mortality disease. The increasing incidence of aerobic Gram-negative pathogens in empyema has become a more urgent problem. [ABSTRACT FROM AUTHOR]