12 Pleural Diseases	99

•However, if lungs are extensively affected in patients on mechanical ventilation who require high positive end-expiratory pressure (PEEP), then better to remove ICD only when the patient improves and off positive-pressure ventilator.

Suggested Reading

1.Ball CG, Wyrzykowski AD, Kirkpatrick AW. Thoracic needle decompression for tension pneumothorax: clinical correlation with catheter length. Can J Surg. 2010;53(3):184–8.

Tension pneumothorax decompression using a 3.2-cm catheter was unsuccessful in up to 65% of cases. When a larger 4.5-cm catheter was used, fewer procedures (4%) failed. Thoracic ultrasonography can be used to confirm placement.

2.Christie NA. Management of pleural space: effusions and empyema. Surg Clin North Am. 2010;90(5):919–34.

This article discusses therapeutic options for the two most common causes of pleural effusions encountered by the surgeon: pleural sepsis and malignant pleural effusions.

3.Bouhemad B, Zhang M, Lu Q. Clinical review: bedside lung ultrasound in critical care practice. Crit Care. 2007;11(1):205.

This reviews the performance of bedside lung ultrasound for diagnosing pleural effusion, pneumothorax, alveolar interstitial syndrome, lung consolidation, pulmonary abscess, and lung recruitment/derecruitment in critically ill patients with acute lung injury.

4.Azoulay E. Pleural effusions in the intensive care unit. Curr Opin Pulm Med. 2003; 9(4):291–7.

The study discusses safety of thoracocentesis in patients receiving invasive mechanical ventilation, distinguishing exudates from transudates, and diagnosing and managing infected pleural effusions in critically ill patients.

5.Mattison LE, Coppage L, Alderman DF. Pleural effusions in the medical ICU: prevalence, causes, and clinical implications. Chest. 1997;111(4):1018–23.

When clinical suspicion for infection is low, observation of effusions in the ICU is warranted initially because most are caused by noninfectious processes that should improve with treatment of the underlying disease.

Websites

1.www.winfocus.org

A website on lung ultrasound by a dedicated group

2.www.criticalecho.com

A comprehensive site for ICU sonography