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We describe a case of a term female infant born in a rural community hospital and who developed a left-sided spontaneous tension pneumothorax shortly after birth. We used telemedicine to guide the family physician and healthcare team at the referring hospital to perform a life-saving thoracentesis using an intravenous cannula. The cannula was kept in place to drain the persistent pneumothorax during transportation to the pediatric intensive care unit at the tertiary hospital. [ABSTRACT FROM AUTHOR]

Thoracic interventions are frequently performed by radiologists, but guidelines on appropriateness criteria and technical considerations to ensure patient safety regarding such interventions is lacking. These guidelines, developed by the Canadian Association of Radiologists, Canadian Association for Interventional Radiology and Canadian Society of Thoracic Radiology focus on the interventions commonly performed by thoracic radiologists. They provide evidence-based recommendations and expert consensus informed best practices for patient preparation; biopsies of the lung, mediastinum, pleura and chest wall; thoracentesis; pre-operative lung nodule localization; and potential complications and their management. [ABSTRACT FROM AUTHOR]

Introduction: Trastuzumab emtansine (T-DM1) is an antibody-drug conjugate which combine trastuzumab (T), a monoclonal antibody targeting the human epidermal growth factor receptor-2 (HER2), and a cytotoxic molecule derived from maytansine (DM1). Case report: We report the first case of T-DM1-associated pleural and pericardial effusions three weeks after the second course of T-DM1 in a patient with breast cancer. Drug-induced pleural and pericardial effusions was implicated in the absence of other etiologies. The Naranjo Scale indicated a probable drug-induced adverse reaction. Management & outcome: The patient fully recovered after thoracentesis and discontinuation of T-DM1. The patient has reported no side effect after the sixth course of trastuzumab. Discussion: To our knowledge, this is the first case in the literature of bilateral pleural and pericardial effusions in a patient treated with T-DM1. The successful initiation of treatment with trastuzumab following withdrawal of T-DM1 suggests that emtansine played a role in the development of bilateral pleural and pericardial effusions. We hypothesize that the patient's condition was a result of a local inflammatory reaction to emtansine by direct toxicity. [ABSTRACT FROM AUTHOR]

Background: Pleural effusions are common in critically ill patients. However, the management of pleural fluid on relevant clinical outcomes is poorly studied. We evaluated the impact of pleural effusion in the intensive care unit (ICU). Methods: A large observational ICU database Multiparameter Intelligent Monitoring in Intensive Care III was utilized. Analyses used matched patients with the same admission diagnosis, age, gender, and disease severity. Results: Of 50 765, 3897 (7.7%) of critically ill adult patients had pleural effusions. Compared to patients without effusion, patients with effusion had higher in-hospital (38.7% vs 31.3%, P <.0001), 1-month (43.1% vs 36.1%, P <.0001), 6-month (63.6% vs 55.7%, P <.0001), and 1-year mortality (73.8% vs 66.1%, P <.0001), as well as increased length of hospital stay (17.6 vs 12.7 days, P <.0001), ICU stay (7.3 vs 5.1 days, P <.0001), need for mechanical ventilation (63.1% vs 55.7%, P <.0001), and duration of mechanical ventilation (8.7 vs 6.3 days, P <.0001). A total of 1503 patients (38.6%) underwent pleural fluid drainage. Patients in the drainage group had higher in-hospital (43.9% vs 35.4%, P =.0002), 1-month (47.7% vs 39.7%, P =.0005), 6-month (67.1% vs 61.8%, P =.0161), and 1-year mortality (77.1% vs 72.1%, P =.0147), as well as increased lengths of hospital stay (22.1 vs 16.0 days, P <.0001), ICU stay (9.2d vs 6.4 days, P <.0001), and duration of mechanical ventilation (11.7 vs 7.1 days, P <.0001). Conclusions: The presence of a pleural effusion was associated with increased mortality in critically ill patients regardless of disease severity. Drainage of pleural effusion was associated with worse outcomes in a large, heterogeneous cohort of ICU patients. [ABSTRACT FROM AUTHOR]

Pleural effusions occur frequently in mechanically ventilated patients, but no consensus exists regarding the clinical benefit of effusion drainage. We sought to determine the impact of thoracentesis on gas exchange in patients with differing severities of acute lung injury (ALI). A retrospective analysis was conducted on therapeutic thoracenteses performed on intubated patients in an adult surgical intensive care unit of a tertiary center. Effusions judged by ultrasound to be 400 mL or larger were drained. Subjects were divided into groups based on their initial P:F ratios: normal >300, ALI 200 to 300, and acute respiratory distress syndrome (ARDS) <200. Baseline characteristics, physiologic variables, arterial blood gases, and ventilator settings before and after the intervention were analyzed. The primary end point was the change in measures of oxygenation. Significant improvements in P:F ratios (mean ± SD) were seen only in patients with ARDS (50.4 ± 38.5, P = 0.001) and ALI (90.6 ± 161.7, P = 0.022). Statistically significant improvement was observed in the pO2 (31.1, P = 0.005) and O2 saturation (4.1, P < 0.001) of the ARDS group. The volume of effusion removed did not correlate with changes in individual patient's oxygenation. These data support the role of therapeutic thoracentesis for intubated patients with abnormal P:F ratios. [ABSTRACT FROM AUTHOR]

In this article, the author recommends use of several measures including treatment with broad-spectrum antibiotics, intrapleural administration of fibrinolytics and video-assisted thoracic surgery in case of parapneumonic effusion (PPE) in children. It mentions increased incidence of parapneumonic effusion (PPE) and empyema in younger children. It also mentions Streptococcus pneumoniae bacteria being common cause for the disease.

Prolonged chylothorax is a rare, life-threatening, pleural effusion that may be encountered in the setting of trauma. Conservative treatment may be successful and is the traditional approach in cases of limited chyle output. Early surgical intervention is required in cases with large refractory chyle output, but may be associated with substantial morbidity and mortality. Percutaneous thoracic duct embolization is an uncommon, minimally invasive, safe and effective treatment alternative. We report a case of successful thoracic duct embolization to treat large-volume chylothorax due to blunt trauma. [ABSTRACT FROM AUTHOR]

Background: It has been suggested that no upper limit of the fluid amount drained is necessary when performing ultrasound-guided thoracentesis, but the risk of pneumothorax when large amounts of fluid are drained has not been studied in detail. Purpose: To study the amount of drained fluid at ultrasound-guided thoracentesis and the subsequent risk of pneumothorax. Material and Methods: Prospectively collected information on all ultrasound-guided thoracenteses performed at a county hospital between 2004 and 2006 was evaluated. In total, 735 thoracenteses in 471 patients were included. Chest radiographs performed within 14 days after thoracentesis were identified to obtain cases of pneumothorax and cases treated with tube thoracostomy. Data were analyzed by logistic regression. The study was approved by the regional research ethics committee. Results: There was a steep increase in risk for pneumothorax when large amounts of fluid were drained. Compared to a thoracentesis of 0.8-1.2 l, drainage of 1.8-2.2 l was associated with a more than threefold increase in risk for pneumothorax (odds ratio [OR] 3.8, 95% confidence interval [CI] 1.28-11.2), and after drainage of 2.3 l or more, the increase in risk was almost sixfold (OR 5.7, 95% CI 1.30-24.7). The association between the amount drained and the risk of pneumothorax was even more pronounced for pneumothoraces requiring tube thoracostomy (P for trend <0.0001). Nine of 11 tube thoracostomies occurred after thoracenteses of 1.8 l or more. Conclusion: Our study suggests that drainage of large amounts of fluid at ultrasound-guided thoracentesis is a risk factor for pneumothorax. [ABSTRACT FROM AUTHOR]

Pleural disease itself is an unusual cause for admission to the intensive care unit (ICU). Pleural complications of diseases and procedures in the ICU are common, however, and the impact on respiratory physiology is additive to that of the underlying cardiopulmonary disease. Pleural effusion and pneumothorax may be overlooked in the critically ill patient due to alterations in radiologic appearance in the supine patient. The development of a pneumothorax in a patient in the ICU represents a potentially life-threatening situation. This article reviews the etiologies, pathophysiology, and management of pleural effusion, pneumothorax, tension pneumothorax, and bronchopleural fistula in the critically ill patient. In addition, we review the potential complications of thoracentesis and chest tube thoracostomy, including reexpansion pulmonary edema. [ABSTRACT FROM AUTHOR]

The objective of this study was to determine the safety and value of thoracentesis in an ICU, Thoracentesis is a safe procedure for critically ill patients, even those on mechanical ventilators, and usually confirms the suspected diagnosis. However, thoracentesis revealed an unexpected diagnosis that changed management in 12% of patients. Repeat or contralateral thoracentesis is indicated when either the clinical course is inconsistent or may represent a complication of the original diagnosis. [ABSTRACT FROM AUTHOR]

This article describes a case study of pancreaticopleural fistula presenting as a recurrent pleural effusion that persisted requiring repeated thoracentesis despite endoscopic placement of pancreatic duct stents. The patient was a 48-year-old man who presented with acute pancreatitis that was presumed to be the result of gallstones and underwent laparoscopic cholecystectomy. His symptoms and fistula quickly resolved after an internal drainage through a Roux-en-Y pancreaticocyst-jejunostomy.

Comments on a paper by G.P. LeMense and S.A. Sahn which provides information concerning the safety and value of the diagnostic and therapeutic procedure, thoracentesis in medical intensive care unit patients. Description of thoracentesis; Factors associated with the discrepancies and complications of the procedure; Risk of pneumothorax from thoracentesis attempts without imaging guidance.

Until 2018, 236 cases of acute pancreatitis have been reported in patients who underwent peritoneal dialysis. Here, we presented a patient with double renal transplantation with chronic renal failure, under renal replacement therapy by peritoneal dialysis, who developed acute pancreatitis with abdominal pain, nausea, vomiting, leukocytosis with neutrophil left shift which is complicated by pancreatic pseudocyst, candida peritonitis, fungal sepsis, overlapping of Acinetobacter baumannii sepsis, and pneumonitis. After the percutaneous cystogastrostomy drainage of pancreatic pseudocyst, changes from peritoneal dialysis to hemodialysis, various thoracentesis, and polyantibiotics therapy, the resolution of the sepsis state was seen. The particular aspect of our case is the various comorbidity risks, severe pancreatitis associated with candida and A baumannii sepsis, and treatment strategy that lead to heal this kind of the high mortality rate condition. [ABSTRACT FROM AUTHOR]

The case of a 47-year-old female who presented with urinoma and urinothorax due to left ureteral calculus obstruction is reported. The left kidney was surgically resected, while the urinothorax was evacuated by therapeutic thoracentesis, which resulted in withdrawal of 18 liters of straw-colored pleural fluid. [ABSTRACT FROM AUTHOR]