Clinical outcomes of pleural drainage on pneumothorax and hydrothorax in critically ill patients with COVID-19: A case series with literature review.
Yuan Xu, Shanqing Li, Hongsheng Liu
PMID 33310504WHAT IT FOUND
In 11 ventilated COVID-19 patients with pleural drainage, oxygenation and gas exchange improved after drainage, but circulation worsened and 8 died.
It cannot show the drainage alone caused benefit or reduced death.
Key findings
01Oxygenation and gas exchange improved after pleural drainage: the PaO2/FiO2 ratio rose from 147.4 mmHg 1 h before drainage to 175.5 mmHg 24 h after drainage (P = 0.013), and the alveolar-arterial oxygen pressure difference fell from 313.3 mmHg 1 h before drainage to 261.3 mmHg 24 h after drainage (P = 0.013).
02Pleural drainage did not reverse circulatory deterioration: norepinephrine increased from 0.15 μg/kg/min 1 h before drainage to 0.40 μg/kg/min 24 h after drainage (P = 0.027).
03None of the 5 chest tubes used were obstructed, while central venous catheters were partially obstructed in 3 drainages and fully obstructed in 2 drainages.
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What it does not show
Only 11 patients were studied, so the results are very small and unstable. There was no control group, so changes after drainage could be due to other treatments, ventilator changes, natural disease course or selection of patients. All patients were receiving mechanical ventilation, and many drainages occurred with glucocorticoids, antibiotics and anticoagulation, so the effect of pleural drainage alone cannot be separated. The study was retrospective, and the authors say some laboratory tests were incomplete. Tube choice depended on operator preference and supply, not a set rule, so comparisons between chest tubes and central venous catheters are not randomised. The patients were critically ill with high mortality, so the findings may not apply to less severe pneumothorax or hydrothorax.
Declared interests
The authors confirm that there are no conflicts of interest.
The easy way to misread this
Do not conclude that pleural drainage alone improved oxygenation or reduced death. This was an uncontrolled case series of 11 patients, and 8 died, while norepinephrine, lactate, NT-proBNP and cardiac troponin I increased after drainage.