Pleural Disease in the Intensive Care Unit

Pleural disease itself is an unusual cause for admission to the intensive care unit (ICU). Conditions potentially requiring ICU admission include a large pleural effusion causing acute respiratory failure, hemothorax producing respiratory or hemodynamic compromise, secondary spontaneous pneumothorax with respiratory failure, empyema with sepsis, and re-expansion pulmonary edema. Pleural complications of disease processes and procedures performed in the ICU are common, however, and the changes in respiratory physiology are additive to that of the underlying lung disease. The development of a pneumothorax in a critically ill patient, particularly in mechanically ventilated patients, may be a life-threatening event. Pleural effusions may be overshadowed by the illness requiring ICU admission in the critically ill patient. Pleural effusions and pneumothoraces may not be detected on chest radiographs because the radiologic appearance may differ in the supine patient.