E2959. Effectiveness and Safety of CT-Guided Pleural Drainage of Critical Care Patients: A Retrospective Cohort Study of Three Intensive Care Units
Authors
Cassiani-Ingoni Etienne;
APHP-CHU Bichat Claude Bernard
Augustin Gaudemer;
APHP-CHU Bichat Claude Bernard; University Paris Cité
Ralph Khoury;
APHP-CHU Bichat Claude Bernard
Debray Marie-Pierre;
APHP-CHU Bichat Claude Bernard; University Paris Cité
Antoine Khalil;
APHP-CHU Bichat Claude Bernard; University Paris Cité
Objective:
Pleural effusions and pneumothoraxes are frequent pathologies in intensive care patients, and are considered severity factors associated to excess mortality. The treatment generally involves pleural drainage, which can be done as a bedside procedure (with or without sonographic guidance), with CT-scan guidance, or surgically. The indications for pleural drainage, particularly under CT guidance, remain unclear in the literature for intensive care patients. This exhibit aims to assess the clinical, radiological efficacy, safety, and complications associated with pleural drainage in intensive care patients under CT guidance.
Materials and Methods:
We performed a retrospective analysis of sequential drainage procedures under CT guidance in intensive care patients. We defined clinical success as no additional drainage required, no surgery required, and no death related to the underlying pathology. We investigated the complications related to the drainage procedure. We searched for associations by performing a bivariate analysis between clinical success rates and clinical and radiological parameters.
Results:
We analysed 131 sequential pleural drainage procedures under CT guidance (117 primary and 14 repeated procedures), performed mainly for infectious pleural effusions (54%) and pneumothoraxes (29%). There were 52 procedures performed under mechanical ventilation and 5 under ECMO. We observed a 68% clinical success rate and 91% radiological success rate. Only two per-procedure complications were reported, and none were transport-related. Pleural drainage was associated with an 8% increase in the PaO2/FiO2 rate and allowed for bacterial identification in 46% of infectious pleural effusions. We found no relation between clinical success and BMI, age, chest tube diameter, the underlying pleural pathology, and the topography of the effusion.
Conclusion:
Pleural drainage under CT guidance in intensive care patients is a safe and efficient procedure, particularly in complex situations not suited to bedside procedures.
