RT Book, Section A1 Patel, Shruti B. A1 McConville, John F. A2 Hall, Jesse B. A2 Schmidt, Gregory A. A2 Kress, John P. SR Print(0) ID 1107719231 T1 Thoracostomy T2 Principles of Critical Care, 4e YR 2015 FD 2015 PB McGraw-Hill Education PP New York, NY SN 9780071738811 LK accesssurgery.mhmedical.com/content.aspx?aid=1107719231 RD 2024/03/28 AB Pneumothorax in critically ill patients is often missed with conventional chest radiography. Ultrasound is a more reliable means of detecting pneumothorax.Pleural effusions can be detected by chest radiograph, chest CT and ultrasound. Ultrasound can be used for real time guidance of thoracentesis and chest tube placement.Empyema is the presence of pus within the pleural space and should be treated with systemic antibiotics as well as insertion of a chest drain. Other relative indications for placement of a chest drain include: positive gram stain or culture of pleural fluid and/or pH <7.2.Recurring pleural effusions (eg, malignancy) can be managed by placement of a tunneled drainage system or pleurodesis (chemical or surgical).Pleurodesis is extremely painful and should always be preceded by aggressive anesthesia and analgesia.Chest tubes placed for pneumothorax should be evaluated daily for air leak. Pleural drainage systems can usually be placed on water seal rather than suction. This may hasten the resolution of leak across the visceral pleura and thus hasten chest tube removal.Chest tube removal can be considered when there is no air leak in the pleural drainage system (pneumothorax) and/or there is less than 100 to 300 mL of fluid drainage per day (effusion).