Disorders of Pleural Space - Pleural Effusion

Jul 13, 2024

Lecture Notes: Disorders of Pleural Space - Pleural Effusion

Introduction

  • Presenter: Eddie Watson from ICU Advantage
  • Goal: Make complex critical care subjects easy to understand
  • Audience Engagement: Subscribe, like, and comment on the channel; visit icuadvantage.com for quizzes and support

Overview: Pleural Effusion

  • Definition: Abnormal collection of excessive fluid in the pleural space
    • Most common pleural disease
    • Results from various conditions
  • Impact: Decreased lung expansion and gas exchange; potential lung collapse
  • Symptoms: May not correlate directly with effusion size

Types and Causes

Pathophysiology

  • Normal Fluid Dynamics: Small amount of serous pleural fluid originates from vasculature, reabsorbed by parietal pleura
    • Hydrostatic pressure drives fluid into pleural space
    • Decreased protein count compared to serum
  • Accumulation: Due to increased production or decreased reabsorption

Classifications

  1. Transudative Effusion: Pressure-Driven Fluid Leak
  • Caused by changes in hydrostatic or oncotic pressure
  • Common Causes: CHF, cirrhosis, hypoalbuminemia, nephrotic syndrome, acute atelectasis, myxedema, peritoneal dialysis
  1. Exudative Effusion: Inflammatory Fluid Leak
  • Caused by increased capillary permeability
  • Common Causes: Pneumonia, cancer, trauma, surgery, pulmonary embolism, autoimmune disorders, pancreatitis
  1. Other Classifications by Fluid Origin
  • Hydrothorax: Serous fluid
  • Hemothorax: Blood
  • Chylothorax: Milky fluid (lymph and fatty acids)
  • Pyothorax/Empyema: Pus
  • Urinothorax: Urine (rare)
  • Iatrogenic Causes: Misplaced feeding tubes, central line perforation

Signs and Symptoms

  • Similar to Pneumothorax
    • Chest pain, shortness of breath, tachypnea, hypoxemia, hypercapnia
    • Decreased/absent breath sounds, reduced tactile fremitus, vocal resonance
    • Dullness to percussion (different from hemothorax)
  • Severe Cases: Tension hydrothorax
    • Decreased cardiac output, severe respiratory and cardiac compromise
    • Signs: Tachycardia, JVD, cyanosis, tracheal deviation, profound hypoxemia, hypotension, respiratory failure, cardiac arrest

Diagnostics

  1. Medical History and Exam
  2. Imaging:
  • Chest X-ray: Posterior Anterior view, costophrenic angle blunting
  • Computed Tomography (CT): Best for location and size
  • Ultrasound: As sensitive as CT, more sensitive than X-ray

Treatment Options

  1. Conservative Treatment
  • For effusions < 300 mL; may involve analgesics, follow-up imaging
  1. Thoracentesis
  • Common, used to drain fluid, ultrasound-guided
  1. Chest Tube
  • For larger effusions; careful of draining too much initially (risk of pulmonary edema)
  • Inserted at 4th/5th intercostal space, mid-axillary line
  • Smaller chest tubes (14-16 French) or pigtails (10-14 gauge)
  1. Surgery
  • For recurrent effusions, sometimes done via VATS or open thoracotomy
  • Chemical/surgical pleurodesis for recurrent cases

Conclusion

  • Summary of pleural effusion and related disorders
  • Encouragement to watch upcoming lessons on chest tube management
  • Call to engage with channel and community

Additional Resources

  • Links to related lessons, channel membership, and nursing gear

Note: This summary provides a foundation in understanding pleural effusion, its types, causes, symptoms, diagnostics, and treatment options.