Prevalence, characteristics, drainage and outcome of radiologically diagnosed pleural effusions in critically ill patients.

OBJECTIVE: Pleural effusions in the intensive care unit (ICU) are clinically important. However, there is limited information regarding effusions in such patients. We aimed to estimate the prevalence, patient characteristics, mortality, effusion duration, radiological resolution, drainage, and reaccumulation rates of pleural effusions in ICU patients. METHODS: This retrospective cohort study assessed all patients admitted to a tertiary hospital ICU from 1 January to 31 December 2015 with a chest x-ray report of pleural effusion. All chest x-ray reports were reviewed and data were combined with an established clinical ICU database. Statistical analysis of the combined dataset was performed. RESULTS: Among 2094 patients admitted to the ICU, 566 (27%) had pleural effusions diagnosed by chest x-ray. The effusion median duration was 3 days (IQR, 1-5 days). Radiologically documented clearance of the effusion occurred in 243 patients (43%) and drainage was performed in 52 patients (9%). Among patients with effusion clearance, 80 (33%) reaccumulated the effusion. Drainage was more common in patients who experienced reaccumulation (19% v 7%; P = 0.004). Overall, 89 patients (16%) died, with 20% mortality among those with reaccumulation versus 9% among patients without reaccumulation (P = 0.037). CONCLUSION: Pleural effusions are common in ICU patients and drainage is infrequent. One-third of effusions reaccumulate, even after drainage, and one in six patients with an effusion die in hospital. This information helps clinicians estimate resolution rates, advantages and disadvantages of effusion drainage, and overall prognosis.

Percutaneous transhepatic laser lithotripsy for intrahepatic cholelithiasis: A technical report.

Advances in interventional radiology have seen the adaptation of urological endoscopic laser techniques to treat biliary tract calculi. Percutaneous transhepatic biliary laser lithotripsy provides an effective alternative procedure for the management of intrahepatic or conventionally refractory choledocholithiasis which would otherwise require invasive and high-risk surgical intervention. Several small studies have validated the procedure for management in this subset of patients, with most achieving 100% calculi clearance with minimal complications. Most patients are suitable for percutaneous transhepatic biliary laser lithotripsy. Preprocedural imaging is useful for evaluating stone burden and planning percutaneous access. Holmium lasers are commonly used and act by vaporising water particles on and in the calculi, fragmenting the stone via thermal expansion. A series of catheters, wires, sheaths and dilators are used to allow introduction of the choledochoscope and laser so that calculi can be targeted. Percutaneous transhepatic biliary laser lithotripsy is often used in conjunction with balloon dredging and biliary stricture dilatation. Only experienced interventionalists should perform this procedure, and users should be aware of associated hazards. Repeat percutaneous transhepatic cholangiography is routinely performed to confirm eradication of stones. Treatment of biliary calculi and obstruction is important in preventing diseases such as cholangitis and cirrhosis. For patients unsuitable for conventional treatment, percutaneous transhepatic laser lithotripsy is a safe and effective alternative when performed by experienced interventional radiologists. Preprocedural planning is imperative to procedure success.