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Respiratory Conditions ~ Pleural Effusion

A pleural effusion occurs when a collection of fluid accumulates in this pleural space. 

What does the Respiratory system do?

Abnormal and or inadequate breathing

Pleural Effusion - What happens?

What Happens in Intensive Care?

How long will the patient remain in Intensive Care?

Date Published

 

What does the Respiratory System do ?

The respiratory system consists of the lungs, airways and blood vessels. The function of the respiratory system is to absorb oxygen into the body and to remove carbon dioxide from the body. A normal breath requires a complex coordination between the nervous system (brain & spinal cord) and the muscles of breathing (including the diaphragm and muscles between the ribs).

Abnormal and or inadequate breathing can occur as a result of:

  • An interruption to the nervous system (head injuries or spinal injuries for example)
  • Barriers to the absorption of oxygen (eg fluid in the alveoli);
  • Obstruction to the flow of gases through the lungs, both breathing in or out (eg asthma);
  • Damage to the rib cage (in motor vehicle trauma for example);
  • Pain, which makes taking a normal breath difficult.

http://users.rcn.com/jkimball.ma.ultranet/BiologyPages/P/Pulmonary.php

 

This image was obtained using a Google image search.

There are many respiratory conditions which if not treated can result in respiratory failure and require the patient to be admitted to a high dependency or intensive care unit for further monitoring and ventilation support (help with breathing). This support may be through the use of oxygen masks, CPAP or via a breathing tube(endotracheal tube) and ventilator (breathing machine).

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Pleural effusion - what happens?

A pleural effusion occurs when a collection of fluid accumulates in this pleural space.  This can occur for a number of reasons that can include:Hydrothorax – a collection of serous or protein fluid (eg pancreatitis or heart failure)

  1. Haemo thorax – a collection of blood usually as the result of chest trauma
  2. Chylothorax – a collection of lymphatic fluid
  3. Para pneumonic effusion – a collection of exudate associated with an infective process such as pneumonia
  4. Empyema – a parapneumonic effusion with pus

This image was obtained using a Google image search

Often a pleural effusion will be identified when a patient has a CXR as not all patients will have signs and symptoms.  However once the fluid has accumulated to around 500mls signs and symptoms, such as shortness of breath (dyspnoea), decreased chest movement and breath sounds on the effected side, will start to occur.The diagnosis of a pleural effusion is made by obtaining a patient history, physical examination and performing a chest x-ray. On chest x-ray an image will be visible (see below) indicating a collection.  If the cause of the effusion is unclear a thoracentesis may be performed. 

This image was obtained using a Google image search

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What happens in intensive care?

Patients are not admitted to ICU with a pleural effusion unless it is quite large and causes a serious deterioration into respiratory function. However patients may have or develop a pleural effusion from other causes whilst in ICU.

Signs and symptoms include:

  • Increased work of breathing / difficulty in breathing
  • High respiratory rate
  • Shallow breathing
  • Low oxygen saturations
  • Anxiety / distress

Treatment of the pleural effusion depends on the underlying cause and not all pleural effusions will be removed or drained.

In thoracentesis the doctor, using a local anaesthetic , carefully inserts a needle through the chest wall into the pleural space and obtains a specimen of fluid. If the collection is large an intercostal drain (chest tube drain and water seal system) may need to be inserted to drain the fluid collection. Repeated effusions may require chemical or surgical pleurodesis, in which the two pleural surfaces are attached to each other so that no fluid can accumulate between them

 

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How long will the patient remain in Intensive Care?

The length of time in ICU and prognosis will depend on the cause of the pleural effusion and the patient’s other diagnoses.  Once stability is achieved, intensive care length of stay will be minimal.

The information contained on this page is general in nature and therefore cannot reflect individual patient variation.  In addition it reflects Australian intensive care practice which may differ from other countries. It is meant as a back up to specific information which will be discussed with you by the Doctors and Nurses caring for your loved one.  ICCMU attests to the accuracy of the information contained here BUT takes no responsibility for how it may apply to an individual patient.  Please refer to the full disclaimer.

Pleural Effusion~ Version 1 (Authors S Dimoski Acting CNC RPA & K Rolls)

First posted August 2008

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In collaboration with the Community and ICU Clinicians, the Intensive Care Coordination & Monitoring Unit (ICCMU) and NSWHealth are committed to promoting excellence across Intensive Care services throughout the State. © ICCMU, NSWHealth.